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001-es BibID:BIBFORM107420
035-os BibID:(scopus)85122939948 (wos)000769111800016
Első szerző:Galimberti, Stefania
Cím:Effect of frailty on 6-month outcome after traumatic brain injury : a multicentre cohort study with external validation / Galimberti Stefania, Graziano Francesca, Maas Andrew I. R., Isernia Giulia, Lecky Fiona, Jain Sonia, Sun Xiaoying, Gardner Raquel C., Taylor Sabrina R., Markowitz Amy J., Manley Geoffrey T., Valsecchi Maria Grazia, Bellelli Giuseppe, Citerio Giuseppe, CENTER-TBI participants and investigators, TRACK-TBI participants and investigators
Dátum:2022
ISSN:1474-4422 1474-4465
Megjegyzések:Summary Background Frailty is known to be associated with poorer outcomes in individuals admitted to hospital for medical conditions requiring intensive care. However, little evidence is available for the effect of frailty on patients' outcomes after traumatic brain injury. Many frailty indices have been validated for clinical practice and show good performance to predict clinical outcomes. However, each is specific to a particular clinical context. We aimed to develop a frailty index to predict 6-month outcomes in patients after a traumatic brain injury. Methods A cumulative deficit approach was used to create a novel frailty index based on 30 items dealing with disease states, current medications, and laboratory values derived from data available from CENTER-TBI, a prospective, longitudinal observational study of patients with traumatic brain injury presenting within 24 h of injury and admitted to a ward or an intensive care unit at 65 centres in Europe between Dec 19, 2014, and Dec 17, 2017. From the individual cumulative CENTER-TBI frailty index (range 0?30), we obtained a standardised value (range 0?1), with high scores indicating higher levels of frailty. The effect of frailty on 6-month outcome evaluated with the extended Glasgow Outcome Scale (GOSE) was assessed through a proportional odds logistic model adjusted for known outcome predictors. An unfavourable outcome was defined as death or severe disability (GOSE score ?4). External validation was performed on data from TRACK-TBI, a prospective observational study co-designed with CENTER-TBI, which enrolled patients with traumatic brain injury at 18 level I trauma centres in the USA from Feb 26, 2014, to July 27, 2018. CENTER-TBI is registered with ClinicalTrials.gov, NCT02210221; TRACK-TBI is registered at ClinicalTrials.gov, NCT02119182. Findings 2993 participants (median age was 51 years [IQR 30?67], 2058 [69%] were men) were included in this analysis. The overall median CENTER-TBI frailty index score was 0?07 (IQR 0?03?0?15), with a median score of 0?17 (0?08?0?27) in older adults (aged ?65 years). The CENTER-TBI frailty index score was significantly associated with the probability of an increasingly unfavourable outcome (cumulative odds ratio [OR] 1?03, 95% CI 1?02?1?04; p<0?0001), and the association was stronger for participants admitted to hospital wards (1? 04, 1?03?1?06, p<0?0001) compared with those admitted to the intensive care unit (1 ?02, 1?01?1?03 p<0?0001). External validation of the CENTER-TBI frailty index in data from the TRACK-TBI (n=1667) cohort supported the robustness and reliability of these findings. The overall median TRACK-TBI frailty index score was 0?03 (IQR 0?0?10), with the frailty index score significantly associated with the risk of an increasingly unfavourable outcome in patients admitted to hospital wards (cumulative OR 1?05, 95% CI 1?03?1?08; p<0?0001), but not in those admitted to the intensive care unit (1?01, 0?99?1?03; p=0?43)
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:Lancet Neurology. - 21 : 2 (2022), p. 153-162. -
További szerzők:Graziano, Francesca Maas, Andrew I. R. Isernia, Giulia Lecky, Fiona Jain, Sonia Sun, Xiaoying Gardner, Raquel C. Taylor, Sabrina R. Markowitz, Amy J. Manley, Geoffrey T. Valsecchi, Maria Grazia Bellelli, Giuseppe Citerio, Giuseppe Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators TRACK-TBI Investigators
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2.

001-es BibID:BIBFORM072262
Első szerző:Maas, Andrew I. R.
Cím:Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research / Andrew I. R. Maas, TBIR Participants and Investigators
Dátum:2017
Megjegyzések:Executive summaryA concerted effort to tackle the global health problemposed by traumatic brain injury (TBI) is long overdue.TBI is a public health challenge of vast, but insufficientlyrecognised, proportions. Worldwide, more than50 million people have a TBI each year, and it is estimatedthat about half the world's population will have one ormore TBIs over their lifetime. TBI is the leading cause ofmortality in young adults and a major cause of death anddisability across all ages in all countries, with adisproportionate burden of disability and death occurringin low-income and middle-income countries (LMICs). Ithas been estimated that TBI costs the global economyapproximately
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Lancet Neurology. - 16 : 12 (2017), p. 987-1048. -
További szerzők:Sándor János (1966-) (orvos-epidemiológus) TBIR Participants and Investigators
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3.

001-es BibID:BIBFORM107489
035-os BibID:(Scopus)85071987996 (WOS)000485784000017
Első szerző:Steyerberg, Ewout W.
Cím: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, David K. Menon, CENTER-TBI Participants and Investigators
Dátum:2019
ISSN:1474-4422 1474-4465
Megjegyzések: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])
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:Lancet Neurology. - 18 : 10 (2019), p. 923-934. -
További szerzők:Wiegers, Eveline Janine Anna Sewalt, Charlie Aletta Buki András Citerio, Giuseppe Keyser, Véronique de Ercole, Ari Kunzmann, Kevin Lanyon, Linda Lecky, Fiona Lingsma, Hester Manley, Geoffrey T. Nelson, David Peul, Wilco C. Stocchetti, Nino von Steinbuechel, Nicole Vande Vyvere, Thijs Verheyden, Jan Wilson, Lindsay Maas, Andrew I. R. Menon, David Krishna Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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4.

001-es BibID:BIBFORM107414
035-os BibID:(scopus)85132454217 (wos)000833401200015
Első szerző:van Essen, Thomas
Cím:Surgery versus conservative treatment for traumatic acute subdural haematoma : a prospective, multicentre, observational, comparative effectiveness study / van Essen Thomas A., Lingsma Hester F., Pisica Dana, Singh Ranjit D., Volovici Victor, den Boogert Hugo F., Younsi Alexander, Peppel Lianne D., Heijenbrok-Kal Majanka H., Ribbers Gerard M., Walchenbach Robert, Menon David K., Hutchinson Peter, Depreitere Bart, Steyerberg Ewout W., Maas Andrew I. R., de Ruiter Godard C. W., Peul Wilco C., CENTER-TBI Collaboration Group
Dátum:2022
ISSN:1474-4422 1474-4465
Megjegyzések:Background Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5?6% to 51?5% (IQR 12?3?35?9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1?8; p<0?0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23?6% [IQR increase]more acute surgery in a centre 0?92, 95% CI 0?77?1?09
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:Lancet Neurology. - 21 : 7 (2022), p. 620-631. -
További szerzők:Lingsma, Hester Pisicǎ, Dana Singh, Ranjit D. Volovici, Victor den Boogert, Hugo F. Younsi, Alexander Peppel, Lianne D. Heijenbrok-Kal, Majanka H. Ribbers, Gerard M. Walchenbach, Robert Menon, David Krishna Hutchinson, Peter Depreitere, Bart Steyerberg, Ewout W. Maas, Andrew I. R. de Ruiter, Godard C. W. Peul, Wilco C. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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5.

001-es BibID:BIBFORM107423
035-os BibID:(scopus)85110576459 (wos)000677684700016
Első szerző:Wiegers, Eveline Janine Anna
Cím:Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI) : a prospective, multicentre, comparative effectiveness study / Wiegers Eveline Janine Anna, Lingsma Hester Floor, Huijben Jilske Antonia, Cooper David James, Citerio Giuseppe, Frisvold Shirin, Helbok Raimund, Maas Andrew Ian Ramsay, Menon David Krishna, Moore Elizabeth Madeleine, Stocchetti Nino, Dippel Diederik Willem, Steyerberg Ewout Willem, van der Jagt Mathieu, CENTER-TBI Collaboration Groups, OzENTER-TBI Collaboration Groups
Dátum:2021
ISSN:1474-4422 1474-4465
Megjegyzések:Background Fluid therapy?the administration of fluids to maintain adequate organ tissue perfusion and oxygenation?is essential in patients admitted to the intensive care unit (ICU) with traumatic brain injury. We aimed to quantify the variability in fluid management policies in patients with traumatic brain injury and to study the effect of this variability on patients' outcomes. Methods We did a prospective, multicentre, comparative effectiveness study of two observational cohorts: CENTER-TBI in Europe and OzENTER-TBI in Australia. Patients from 55 hospitals in 18 countries, aged 16 years or older with traumatic brain injury requiring a head CT, and admitted to the ICU were included in this analysis. We extracted data on demographics, injury, and clinical and treatment characteristics, and calculated the mean daily fluid balance (difference between fluid input and loss) and mean daily fluid input during ICU stay per patient. We analysed the association of fluid balance and input with ICU mortality and functional outcome at 6 months, measured by the Glasgow Outcome Scale Extended (GOSE). Patient-level analyses relied on adjustment for key characteristics per patient, whereas centre-level analyses used the centre as the instrumental variable. Findings 2125 patients enrolled in CENTER-TBI and OzENTER-TBI between Dec 19, 2014, and Dec 17, 2017, were eligible for inclusion in this analysis. The median age was 50 years (IQR 31 to 66) and 1566 (74%) of patients were male. The median of the mean daily fluid input ranged from 1?48 L (IQR 1?12 to 2?09) to 4?23 L (3?78 to 4?94) across centres. The median of the mean daily fluid balance ranged from ?0?85 L (IQR ?1?51 to ?0?49) to 1?13 L (0?99 to 1?37) across centres. In patient-level analyses, a mean positive daily fluid balance was associated with higher ICU mortality (odds ratio [OR] 1?10 [95% CI 1?07 to 1?12] per 0?1 L increase) and worse functional outcome (1?04 [1?02 to 1?05] per 0?1 L increase); higher mean daily fluid input was also associated with higher ICU mortality (1?05 [1?03 to 1?06] per 0?1 L increase) and worse functional outcome (1?04 [1?03 to 1?04] per 1-point decrease of the GOSE per 0?1?L increase). Centre-level analyses showed similar associations of higher fluid balance with ICU mortality (OR 1?17 [95% CI 1?05 to 1?29]) and worse functional outcome (1?07 [1?02 to 1?13]), but higher fluid input was not associated with ICU mortality (OR 0?95 [0?90 to 1?00]) or worse functional outcome (1?01 [0?98 to 1?03]).
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:Lancet Neurology. - 20 : 8 (2021), p. 627-638. -
További szerzők:Lingsma, Hester Huijben, Jilske A. Cooper, David James Citerio, Giuseppe Frisvold, Shirin Helbok, Raimund Maas, Andrew I. R. Menon, David Krishna Moore, Elizabeth Madeleine Stocchetti, Nino Dippel, Diederik W. Steyerberg, Ewout W. van der Jagt, Mathieu Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators OzENTER-TBI Collaboration Groups
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