Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI

a European prospective, multicentre, longitudinal, cohort study

Ewout W. Steyerberg, Eveline Wiegers, Charlie Sewalt, Andras Buki, Giuseppe Citerio, Véronique De Keyser, Ari Ercole, Kevin Kunzmann, Linda Lanyon, Fiona Lecky, Hester Lingsma, Geoffrey Manley, David Nelson, Wilco Peul, Nino Stocchetti, Nicole von Steinbüchel, Thijs Vande Vyvere, Jan Verheyden, Lindsay Wilson, Andrew I.R. Maas & 2 others David K. Menon, CENTER-TBI Investigators and Participants

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)

Abstract

Background: The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. Methods: CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). Findings: Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13–15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30–66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97–1·14]), but mortality was lower than expected (0·70 [0·62–0·76]). Interpretation: Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. Funding: European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.

Original languageEnglish
Pages (from-to)923-934
Number of pages12
JournalThe Lancet Neurology
Volume18
Issue number10
DOIs
Publication statusPublished - Oct 2019

Cite this

Steyerberg, E. W., Wiegers, E., Sewalt, C., Buki, A., Citerio, G., De Keyser, V., ... CENTER-TBI Investigators and Participants (2019). Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. The Lancet Neurology, 18(10), 923-934. https://doi.org/10.1016/S1474-4422(19)30232-7
Steyerberg, Ewout W. ; Wiegers, Eveline ; Sewalt, Charlie ; Buki, Andras ; Citerio, Giuseppe ; De Keyser, Véronique ; Ercole, Ari ; Kunzmann, Kevin ; Lanyon, Linda ; Lecky, Fiona ; Lingsma, Hester ; Manley, Geoffrey ; Nelson, David ; Peul, Wilco ; Stocchetti, Nino ; von Steinbüchel, Nicole ; Vande Vyvere, Thijs ; Verheyden, Jan ; Wilson, Lindsay ; Maas, Andrew I.R. ; Menon, David K. ; CENTER-TBI Investigators and Participants. / Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI : a European prospective, multicentre, longitudinal, cohort study. In: The Lancet Neurology. 2019 ; Vol. 18, No. 10. pp. 923-934.
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title = "Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study",
abstract = "Background: The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. Methods: CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). Findings: Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19{\%}) patients were in the ER stratum, 1523 (34{\%}) in the admission stratum, and 2138 (47{\%}) in the ICU stratum. In the ICU stratum, 720 (36{\%}) patients had mild TBI (GCS score 13–15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43{\%}]) and admission (8571 [38{\%}]) strata, with more than 95{\%} of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30–66], 1254 [28{\%}] aged >65 years), 462 (11{\%}) had serious comorbidities, 772 (18{\%}) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25{\%}) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30{\%}) patients in the ER stratum, 665 (53{\%}) in the admission stratum, and 1547 (84{\%}) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55{\%}) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95{\%} CI 0·97–1·14]), but mortality was lower than expected (0·70 [0·62–0·76]). Interpretation: Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. Funding: European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.",
author = "Steyerberg, {Ewout W.} and Eveline Wiegers and Charlie Sewalt and Andras Buki and Giuseppe Citerio and {De Keyser}, V{\'e}ronique and Ari Ercole and Kevin Kunzmann and Linda Lanyon and Fiona Lecky and Hester Lingsma and Geoffrey Manley and David Nelson and Wilco Peul and Nino Stocchetti and {von Steinb{\"u}chel}, Nicole and {Vande Vyvere}, Thijs and Jan Verheyden and Lindsay Wilson and Maas, {Andrew I.R.} and Menon, {David K.} and Cecilia Ackerlund and Krisztina Amrein and Nada Andelic and Lasse Andreassen and Audny Anke and Anna Antoni and G{\'e}rard Audibert and Kaspars Auslands and Philippe Azouvi and Azzolini, {Maria Luisa} and Rafael Badenes and Ronald Bartels and P{\'a}l Barz{\'o} and Romuald Beauvais and Ronny Beer and Bellander, {Bo Michael} and Antonio Belli and Habib Benali and Maurizio Berardino and Luigi Beretta and Morten Blaabjerg and Peter Bragge and Alexandra Brazinova and Vibeke Brinck and Joanne Brooker and Camilla Brorsson and Monika Bullinger and Manuel Cabeleira and Alessio Caccioppola and Emiliana Calappi and Calvi, {Maria Rosa} and Peter Cameron and {Carbayo Lozano}, Guillermo and Marco Carbonara and Casta{\~n}o-Le{\'o}n, {Ana M.} and Giorgio Chevallard and Arturo Chieregato and Maryse Cnossen and Mark Coburn and Jonathan Coles and Cooper, {Jamie D.} and Marta Correia and Amra Čović and Nicola Curry and Endre Czeiter and Marek Czosnyka and Claire Dahyot-Fizelier and Helen Dawes and Vincent Degos and {Della Corte}, Francesco and {den Boogert}, Hugo and Bart Depreitere and Simone Dijkland and Đula Đilvesi and Abhishek Dixit and Emma Donoghue and Jens Dreier and Duli{\`e}re, {Guy Loup} and Patrick Esser and Erzs{\'e}bet Ezer and Martin Fabricius and Feigin, {Valery L.} and Kelly Foks and Shirin Frisvold and Alex Furmanov and Pablo Gagliardo and Damien Galanaud and Dashiell Gantner and Guoyi Gao and Pradeep George and Alexandre Ghuysen and Lelde Giga and Ben Glocker and Jagoš Golubović and Gomez, {Pedro A.} and Johannes Gratz and Benjamin Gravesteijn and Francesca Grossi and Gruen, {Russell L.} and Deepak Gupta and Haagsma, {Juanita A.} and Iain Haitsma and Raimund Helbok and Eirik Helseth and Lindsay Horton and Jilske Huijben and Hutchinson, {Peter J.} and Bram Jacobs and Stefan Jankowski and Mike Jarrett and Jiang, {Ji yao} and Kelly Jones and Mladen Karan and Kolias, {Angelos G.} and Erwin Kompanje and Daniel Kondziella and Evgenios Koraropoulos and Koskinen, {Lars Owe} and No{\'e}mi Kov{\'a}cs and Alfonso Lagares and Steven Laureys and Rolf Lefering and Valerie Legrand and Aurelie Lejeune and Leon Levi and Roger Lightfoot and Angels Lozano and Marc Maegele and Marek Majdan and Alex Manara and Hugues Mar{\'e}chal and Costanza Martino and Julia Mattern and Catherine McMahon and B{\'e}la Melegh and Tomas Menovsky and Davide Mulazzi and Visakh Muraleedharan and Lynnette Murray and Nandesh Nair and Ancuta Negru and Virginia Newcombe and Daan Nieboer and Quentin Noirhomme and J{\'o}zsef Nyir{\'a}di and Mauro Oddo and Matej Oresic and Fabrizio Ortolano and Olubukola Otesile and Aarno Palotie and Parizel, {Paul M.} and Payen, {Jean Fran{\cc}ois} and Natascha Perera and Vincent Perlbarg and Paolo Persona and Anna Piippo-Karjalainen and {Pili Floury}, S{\'e}bastien and Matti Pirinen and Horia Ples and Suzanne Polinder and Inigo Pomposo and Posti, {Jussi P.} and Louis Puybasset and Andreea Rădoi and Arminas Ragauskas and Rahul Raj and Malinka Rambadagalla and Ruben Real and Jonathan Rhodes and Sylvia Richardson and Sophie Richter and Samuli Ripatti and Saulius Rocka and Cecilie Roe and Olav Roise and Jonathan Rosand and Rosenfeld, {Jeffrey V.} and Christina Rosenlund and Guy Rosenthal and Rolf Rossaint and Sandra Rossi and Daniel Rueckert and Martin Rusn{\'a}k and Juan Sahuquillo and Oliver Sakowitz and Renan Sanchez-Porras and Janos Sandor and Nadine Sch{\"a}fer and Silke Schmidt and Herbert Schoechl and Guus Schoonman and Schou, {Rico Frederik} and Elisabeth Schwendenwein and Toril Skandsen and Peter Smielewski and Abayomi Sorinola and Emmanuel Stamatakis and Simon Stanworth and Ana Stevanovic and Robert Stevens and William Stewart and Nina Sundstr{\"o}m and Anneliese Synnot and Riikka Takala and Vikt{\'o}ria Tam{\'a}s and Tomas Tamosuitis and Taylor, {Mark Steven} and {Te Ao}, Braden and Olli Tenovuo and Alice Theadom and Matt Thomas and Dick Tibboel and Marjolijn Timmers and Christos Tolias and Tony Trapani and Tudora, {Cristina Maria} and Peter Vajkoczy and Egils Valeinis and Shirley Vallance and Zolt{\'a}n V{\'a}mos and {van der Naalt}, Joukje and {Van der Steen}, Gregory and {van Dijck}, {Jeroen T.J.M.} and {van Essen}, {Thomas A.} and {Van Hecke}, Wim and {van Heugten}, Caroline and {Van Praag}, Dominique and {van Wijk}, {Roel P.J.} and Audrey Vanhaudenhuyse and Alessia Vargiolu and Emmanuel Vega and Kimberley Velt and Vespa, {Paul M.} and Anne Vik and Rimantas Vilcinis and Victor Volovici and Daphne Voormolen and Petar Vulekovic and Wang, {Kevin K.W.} and Guy Williams and Stefan Winzeck and Stefan Wolf and Zhihui Yang and Peter Yl{\'e}n and Alexander Younsi and Zeiler, {Frederick A.} and Veronika Zelinkova and Agate Ziverte and Tommaso Zoerle and {CENTER-TBI Investigators and Participants}",
year = "2019",
month = "10",
doi = "10.1016/S1474-4422(19)30232-7",
language = "English",
volume = "18",
pages = "923--934",
journal = "The Lancet Neurology",
issn = "1474-4422",
publisher = "Elsevier",
number = "10",

}

Steyerberg, EW, Wiegers, E, Sewalt, C, Buki, A, Citerio, G, De Keyser, V, Ercole, A, Kunzmann, K, Lanyon, L, Lecky, F, Lingsma, H, Manley, G, Nelson, D, Peul, W, Stocchetti, N, von Steinbüchel, N, Vande Vyvere, T, Verheyden, J, Wilson, L, Maas, AIR, Menon, DK & CENTER-TBI Investigators and Participants 2019, 'Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study', The Lancet Neurology, vol. 18, no. 10, pp. 923-934. https://doi.org/10.1016/S1474-4422(19)30232-7

Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI : a European prospective, multicentre, longitudinal, cohort study. / Steyerberg, Ewout W.; Wiegers, Eveline; Sewalt, Charlie; Buki, Andras; Citerio, Giuseppe; De Keyser, Véronique; Ercole, Ari; Kunzmann, Kevin; Lanyon, Linda; Lecky, Fiona; Lingsma, Hester; Manley, Geoffrey; Nelson, David; Peul, Wilco; Stocchetti, Nino; von Steinbüchel, Nicole; Vande Vyvere, Thijs; Verheyden, Jan; Wilson, Lindsay; Maas, Andrew I.R.; Menon, David K.; CENTER-TBI Investigators and Participants.

In: The Lancet Neurology, Vol. 18, No. 10, 10.2019, p. 923-934.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI

T2 - a European prospective, multicentre, longitudinal, cohort study

AU - Steyerberg, Ewout W.

AU - Wiegers, Eveline

AU - Sewalt, Charlie

AU - Buki, Andras

AU - Citerio, Giuseppe

AU - De Keyser, Véronique

AU - Ercole, Ari

AU - Kunzmann, Kevin

AU - Lanyon, Linda

AU - Lecky, Fiona

AU - Lingsma, Hester

AU - Manley, Geoffrey

AU - Nelson, David

AU - Peul, Wilco

AU - Stocchetti, Nino

AU - von Steinbüchel, Nicole

AU - Vande Vyvere, Thijs

AU - Verheyden, Jan

AU - Wilson, Lindsay

AU - Maas, Andrew I.R.

AU - Menon, David K.

AU - Ackerlund, Cecilia

AU - Amrein, Krisztina

AU - Andelic, Nada

AU - Andreassen, Lasse

AU - Anke, Audny

AU - Antoni, Anna

AU - Audibert, Gérard

AU - Auslands, Kaspars

AU - Azouvi, Philippe

AU - Azzolini, Maria Luisa

AU - Badenes, Rafael

AU - Bartels, Ronald

AU - Barzó, Pál

AU - Beauvais, Romuald

AU - Beer, Ronny

AU - Bellander, Bo Michael

AU - Belli, Antonio

AU - Benali, Habib

AU - Berardino, Maurizio

AU - Beretta, Luigi

AU - Blaabjerg, Morten

AU - Bragge, Peter

AU - Brazinova, Alexandra

AU - Brinck, Vibeke

AU - Brooker, Joanne

AU - Brorsson, Camilla

AU - Bullinger, Monika

AU - Cabeleira, Manuel

AU - Caccioppola, Alessio

AU - Calappi, Emiliana

AU - Calvi, Maria Rosa

AU - Cameron, Peter

AU - Carbayo Lozano, Guillermo

AU - Carbonara, Marco

AU - Castaño-León, Ana M.

AU - Chevallard, Giorgio

AU - Chieregato, Arturo

AU - Cnossen, Maryse

AU - Coburn, Mark

AU - Coles, Jonathan

AU - Cooper, Jamie D.

AU - Correia, Marta

AU - Čović, Amra

AU - Curry, Nicola

AU - Czeiter, Endre

AU - Czosnyka, Marek

AU - Dahyot-Fizelier, Claire

AU - Dawes, Helen

AU - Degos, Vincent

AU - Della Corte, Francesco

AU - den Boogert, Hugo

AU - Depreitere, Bart

AU - Dijkland, Simone

AU - Đilvesi, Đula

AU - Dixit, Abhishek

AU - Donoghue, Emma

AU - Dreier, Jens

AU - Dulière, Guy Loup

AU - Esser, Patrick

AU - Ezer, Erzsébet

AU - Fabricius, Martin

AU - Feigin, Valery L.

AU - Foks, Kelly

AU - Frisvold, Shirin

AU - Furmanov, Alex

AU - Gagliardo, Pablo

AU - Galanaud, Damien

AU - Gantner, Dashiell

AU - Gao, Guoyi

AU - George, Pradeep

AU - Ghuysen, Alexandre

AU - Giga, Lelde

AU - Glocker, Ben

AU - Golubović, Jagoš

AU - Gomez, Pedro A.

AU - Gratz, Johannes

AU - Gravesteijn, Benjamin

AU - Grossi, Francesca

AU - Gruen, Russell L.

AU - Gupta, Deepak

AU - Haagsma, Juanita A.

AU - Haitsma, Iain

AU - Helbok, Raimund

AU - Helseth, Eirik

AU - Horton, Lindsay

AU - Huijben, Jilske

AU - Hutchinson, Peter J.

AU - Jacobs, Bram

AU - Jankowski, Stefan

AU - Jarrett, Mike

AU - Jiang, Ji yao

AU - Jones, Kelly

AU - Karan, Mladen

AU - Kolias, Angelos G.

AU - Kompanje, Erwin

AU - Kondziella, Daniel

AU - Koraropoulos, Evgenios

AU - Koskinen, Lars Owe

AU - Kovács, Noémi

AU - Lagares, Alfonso

AU - Laureys, Steven

AU - Lefering, Rolf

AU - Legrand, Valerie

AU - Lejeune, Aurelie

AU - Levi, Leon

AU - Lightfoot, Roger

AU - Lozano, Angels

AU - Maegele, Marc

AU - Majdan, Marek

AU - Manara, Alex

AU - Maréchal, Hugues

AU - Martino, Costanza

AU - Mattern, Julia

AU - McMahon, Catherine

AU - Melegh, Béla

AU - Menovsky, Tomas

AU - Mulazzi, Davide

AU - Muraleedharan, Visakh

AU - Murray, Lynnette

AU - Nair, Nandesh

AU - Negru, Ancuta

AU - Newcombe, Virginia

AU - Nieboer, Daan

AU - Noirhomme, Quentin

AU - Nyirádi, József

AU - Oddo, Mauro

AU - Oresic, Matej

AU - Ortolano, Fabrizio

AU - Otesile, Olubukola

AU - Palotie, Aarno

AU - Parizel, Paul M.

AU - Payen, Jean François

AU - Perera, Natascha

AU - Perlbarg, Vincent

AU - Persona, Paolo

AU - Piippo-Karjalainen, Anna

AU - Pili Floury, Sébastien

AU - Pirinen, Matti

AU - Ples, Horia

AU - Polinder, Suzanne

AU - Pomposo, Inigo

AU - Posti, Jussi P.

AU - Puybasset, Louis

AU - Rădoi, Andreea

AU - Ragauskas, Arminas

AU - Raj, Rahul

AU - Rambadagalla, Malinka

AU - Real, Ruben

AU - Rhodes, Jonathan

AU - Richardson, Sylvia

AU - Richter, Sophie

AU - Ripatti, Samuli

AU - Rocka, Saulius

AU - Roe, Cecilie

AU - Roise, Olav

AU - Rosand, Jonathan

AU - Rosenfeld, Jeffrey V.

AU - Rosenlund, Christina

AU - Rosenthal, Guy

AU - Rossaint, Rolf

AU - Rossi, Sandra

AU - Rueckert, Daniel

AU - Rusnák, Martin

AU - Sahuquillo, Juan

AU - Sakowitz, Oliver

AU - Sanchez-Porras, Renan

AU - Sandor, Janos

AU - Schäfer, Nadine

AU - Schmidt, Silke

AU - Schoechl, Herbert

AU - Schoonman, Guus

AU - Schou, Rico Frederik

AU - Schwendenwein, Elisabeth

AU - Skandsen, Toril

AU - Smielewski, Peter

AU - Sorinola, Abayomi

AU - Stamatakis, Emmanuel

AU - Stanworth, Simon

AU - Stevanovic, Ana

AU - Stevens, Robert

AU - Stewart, William

AU - Sundström, Nina

AU - Synnot, Anneliese

AU - Takala, Riikka

AU - Tamás, Viktória

AU - Tamosuitis, Tomas

AU - Taylor, Mark Steven

AU - Te Ao, Braden

AU - Tenovuo, Olli

AU - Theadom, Alice

AU - Thomas, Matt

AU - Tibboel, Dick

AU - Timmers, Marjolijn

AU - Tolias, Christos

AU - Trapani, Tony

AU - Tudora, Cristina Maria

AU - Vajkoczy, Peter

AU - Valeinis, Egils

AU - Vallance, Shirley

AU - Vámos, Zoltán

AU - van der Naalt, Joukje

AU - Van der Steen, Gregory

AU - van Dijck, Jeroen T.J.M.

AU - van Essen, Thomas A.

AU - Van Hecke, Wim

AU - van Heugten, Caroline

AU - Van Praag, Dominique

AU - van Wijk, Roel P.J.

AU - Vanhaudenhuyse, Audrey

AU - Vargiolu, Alessia

AU - Vega, Emmanuel

AU - Velt, Kimberley

AU - Vespa, Paul M.

AU - Vik, Anne

AU - Vilcinis, Rimantas

AU - Volovici, Victor

AU - Voormolen, Daphne

AU - Vulekovic, Petar

AU - Wang, Kevin K.W.

AU - Williams, Guy

AU - Winzeck, Stefan

AU - Wolf, Stefan

AU - Yang, Zhihui

AU - Ylén, Peter

AU - Younsi, Alexander

AU - Zeiler, Frederick A.

AU - Zelinkova, Veronika

AU - Ziverte, Agate

AU - Zoerle, Tommaso

AU - CENTER-TBI Investigators and Participants

PY - 2019/10

Y1 - 2019/10

N2 - Background: The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. Methods: CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). Findings: Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13–15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30–66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97–1·14]), but mortality was lower than expected (0·70 [0·62–0·76]). Interpretation: Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. Funding: European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.

AB - Background: The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI. Methods: CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582). Findings: Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13–15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30–66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97–1·14]), but mortality was lower than expected (0·70 [0·62–0·76]). Interpretation: Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes. Funding: European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.

UR - http://www.scopus.com/inward/record.url?scp=85071987996&partnerID=8YFLogxK

U2 - 10.1016/S1474-4422(19)30232-7

DO - 10.1016/S1474-4422(19)30232-7

M3 - Article

VL - 18

SP - 923

EP - 934

JO - The Lancet Neurology

JF - The Lancet Neurology

SN - 1474-4422

IS - 10

ER -