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001-es BibID:	BIBFORM104837
035-os BibID:	(Scopus)85088991849 (WOS)000572673400042
Első szerző:	Gravesteijn, Benjamin Yaël
Cím:	Tracheal intubation in traumatic brain injury : a multicentre prospective observational study / Benjamin Yael Gravesteijn, Charlie Aletta Sewalt, Daan Nieboer, David Krishna Menon, Andrew Maas, Fiona Lecky, Markus Klimek, Hester Floor Lingsma, CENTERTBI collaboratorsy
Dátum:	2020
ISSN:	0007-0912
Megjegyzések:	Abstract Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n?4509). For prehospital intubation, we excluded self- presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio?1.01; 95% confidence interval, 0.79e1.28; P?0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio?0.86; 95% confidence interval, 0.65e1.13; P?0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P?0.009 and P?0.02, respectively), whereas in- hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P?0.01): in- hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221
Tárgyszavak:	Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk effectiveness Europe neurological outcome prehospital tracheal intubation traumatic brain injury
Megjelenés:	British Journal Of Anaesthesia. - 125 : 4 (2020), p. 505-517. -
További szerzők:	Sewalt, Charlie Aletta Nieboer, Daan Menon, David Krishna Maas, Andrew I. R. Lecky, Fiona Klimek, Markus Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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001-es BibID:	BIBFORM104832
Első szerző:	Gravesteijn, Benjamin Yaël
Cím:	Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury / Benjamin Y. Gravesteijn, Daan Nieboer, Ari Ercole, Hester F. Lingsma, David Nelson, Ben van Calster, Ewout W. Steyerberg, CENTER-TBI collaborators
Dátum:	2020
ISSN:	0895-4356
Megjegyzések:	Objective We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. Study Design and Setting We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. Results In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. Conclusion ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations.
Tárgyszavak:	Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk Machine learning Prognosis Traumatic brain injury Prediction Data science Cohort study
Megjelenés:	Journal Of Clinical Epidemiology. - 122 (2020), p. 95-107. -
További szerzők:	Nieboer, Daan Ercole, Ari Lingsma, Hester Nelson, David Calster, Ben van Steyerberg, Ewout W. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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001-es BibID:	BIBFORM107422
035-os BibID:	(cikkazonosító)e1003761 (scopus)85114922058 (wos)000724338300003
Első szerző:	Lecky, Fiona
Cím:	The burden of traumatic brain injury from low-energy falls among patients from 18 countries in the CENTER-TBI Registry : a comparative cohort study / Lecky Fiona E., Otesile Olubukola, Marincowitz Carl, Majdan Marek, Nieboer Daan, Lingsma Hester F., Maegele Marc, Citerio Giuseppe, Stocchetti Nino, Steyerberg Ewout W., Menon David K., Maas Andrew I. R., CENTER-TBI Participants and Investigators
Dátum:	2021
ISSN:	1549-1676
Megjegyzések:	Background Traumatic brain injury (TBI) is an important global public health burden, where those injured by high-energy transfer (e.g., road traffic collisions) are assumed to have more severe injury and are prioritised by emergency medical service trauma triage tools. However recent studies suggest an increasing TBI disease burden in older people injured through low-energy falls. We aimed to assess the prevalence of low-energy falls among patients presenting to hospital with TBI, and to compare their characteristics, care pathways, and outcomes to TBI caused by high-energy trauma. Methods and findings We conducted a comparative cohort study utilising the CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) Registry, which recorded patient demographics, injury, care pathway, and acute care outcome data in 56 acute trauma receiving hospitals across 18 countries (17 countries in Europe and Israel). Patients presenting with TBI and indications for computed tomography (CT) brain scan between 2014 to 2018 were purposively sampled. The main study outcomes were (i) the prevalence of low-energy falls causing TBI within the overall cohort and (ii) comparisons of TBI patients injured by low-energy falls to TBI patients injured by high-energy transfer?in terms of demographic and injury characteristics, care pathways, and hospital mortality. In total, 22,782 eligible patients were enrolled, and study outcomes were analysed for 21,681 TBI patients with known injury mechanism; 40% (95% CI 39% to 41%) (8,622/21,681) of patients with TBI were injured by low-energy falls. Compared to 13,059 patients injured by high-energy transfer (HE cohort), the those injured through low-energy falls (LE cohort) were older (LE cohort, median 74 [IQR 56 to 84] years, versus HE cohort, median 42 [IQR 25 to 60] years; p < 0.001), more often female (LE cohort, 50% [95% CI 48% to 51%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001), more frequently taking pre-injury anticoagulants or/and platelet aggregation inhibitors (LE cohort, 44% [95% CI 42% to 45%], versus HE cohort, 13% [95% CI 11% to 14%]; p < 0.001), and less often presenting with moderately or severely impaired conscious level (LE cohort, 7.8% [95% CI 5.6% to 9.8%], versus HE cohort, 10% [95% CI 8.7% to 12%]; p < 0.001), but had similar in-hospital mortality (LE cohort, 6.3% [95% CI 4.2% to 8.3%], versus HE cohort, 7.0% [95% CI 5.3% to 8.6%]; p = 0.83). The CT brain scan traumatic abnormality rate was 3% lower in the LE cohort (LE cohort, 29% [95% CI 27% to 31%], versus HE cohort, 32% [95% CI 31% to 34%]; p < 0.001); individuals in the LE cohort were 50% less likely to receive critical care (LE cohort, 12% [95% CI 9.5% to 13%], versus HE cohort, 24% [95% CI 23% to 26%]; p < 0.001) or emergency interventions (LE cohort, 7.5% [95% CI 5.4% to 9.5%], versus HE cohort, 13% [95% CI 12% to 15%]; p < 0.001) than patients injured by high-energy transfer. The purposive sampling strategy and censorship of patient outcomes beyond hospital discharge are the main study limitations. Conclusions We observed that patients sustaining TBI from low-energy falls are an important component of the TBI disease burden and a distinct demographic cohort; further, our findings suggest that energy transfer may not predict intracranial injury or acute care mortality in patients with TBI presenting to hospital. This suggests that factors beyond energy transfer level may be more relevant to prehospital and emergency department TBI triage in older people. A specific focus to improve prevention and care for patients sustaining TBI from low-energy falls is required.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk traumatic brain injury
Megjelenés:	PLOS Medicine. - 18 : 9 (2021), p. 1-22. -
További szerzők:	Otesile, Olubukola Marincowitz, Carl Majdan, Marek Nieboer, Daan Lingsma, Hester Maegele, Marc Citerio, Giuseppe Stocchetti, Nino Steyerberg, Ewout W. Menon, David Krishna Maas, Andrew I. R. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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