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001-es BibID:BIBFORM107337
035-os BibID:(cikkazonosító)228 (scopus)85135370588 (wos)000831208500002
Első szerző:Åkerlund, Cecilia
Cím:Clustering identifies endotypes of traumatic brain injury in an intensive care cohort : a CENTER-TBI study / Ảkerlund Cecilia A. I., Holst Anders, Stocchetti Nino, Steyerberg Ewout W., Menon David K., Ercole Ari, Nelson David W., CENTER-TBI Participants and Investigators
Dátum:2022
ISSN:1364-8535
Megjegyzések:Abstract Background: While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classifcation of traumatic brain injury (TBI) as ♭mild', ♭moderate' or ♭severe' based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods: We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (<24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N=1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results: Six stable endotypes were identifed with distinct GCS and composite systemic metabolic stress profles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ♭moderate' TBI (by traditional classifcation) and deranged metabolic profle, had a worse outcome than a cluster with ♭severe' GCS and a normal metabolic profle. Addition of cluster labels signifcantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p<0.001). Conclusions: Six stable and clinically distinct TBI endotypes were identifed by probabilistic unsupervised clustering. In addition to presenting neurology, a profle of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refning current TBI classifcations with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identifcation Portal (RRID: SCR_015582)
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Endotypes
Intensive care unit
Critical care
Unsupervised clustering
Machine learning
Megjelenés:Critical Care. - 26 : 1 (2022), p. 1-15. -
További szerzők:Holst, Anders Stocchetti, Nino Steyerberg, Ewout W. Menon, David Krishna Ercole, Ari Nelson, David W. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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2.

001-es BibID:BIBFORM105073
035-os BibID:(WOS)000382876700016 (Scopus)84991063666 (cikkazonosító)e0161367
Első szerző:Cnossen, Maryse C.
Cím:Variation in Structure and Process of Care in Traumatic Brain Injury : provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study / Maryse C. Cnossen, Suzanne Polinder, Hester F. Lingsma, Andrew I. R. Maas, David Menon, Ewout W. Steyerberg, CENTER-TBI Investigators and Participants
Dátum:2016
ISSN:1932-6203
Megjegyzések:Abstract Introduction The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general struc tural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Methods We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, ques tionnaires were disseminated to 71 centers from 20 countries participating in the CENTER TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. Results All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), desig nated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabili tation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addi tion, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers.Conclusion Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effec tiveness of specific aspects of TBI care and to identify best practices with CER approaches.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Plos One. - 11 : 8 (2016), p. 1-21. -
További szerzők:Polinder, Suzanne Lingsma, Hester Maas, Andrew I. R. Menon, David Krishna Steyerberg, Ewout W. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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3.

001-es BibID:BIBFORM070421
Első szerző:Cnossen, Maryse C.
Cím:Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury : a survey in 66 neurotrauma centers participating in the CENTER-TBI study / Maryse C. Cnossen, Jilske A. Huijben, Mathieu van der Jagt, Victor Volovici, Thomas van Essen, Suzanne Polinder, David Nelson, Ari Ercole, Nino Stocchetti, Giuseppe Citerio, Wilco C. Peul, Andrew I. R. Maas, David Menon, Ewout W. Steyerberg, Hester F. Lingsma, CENTER-TBI Investigators and Participants
Dátum:2017
ISSN:1364-8535 1466-609X
Megjegyzések:Background: No definitive evidence exists on how intracranial hypertension should be treated in patients withtraumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefitsand risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim ofthis study was to examine variation in monitoring and treatment policies for intracranial hypertension in patientswith TBI.Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expertopinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participatingin the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals(n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines wereused in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor inpatients with severe TBI and computed tomographic abnormalities. There was no consensus on other indicationsor on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevatedICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring andtreatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%).Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI andintracranial hypertension. The results of this survey indicate a lack of consensus between European neurotraumacenters and provide an opportunity and necessity for comparative effectiveness research.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Traumatic brain injury
Intracranial hypertension
ICP
ICU
Comparative effectiveness research
Survey
Megjelenés:Critical Care. - 21/2017 (2017), p. 233-245. -
További szerzők:Huijben, Jilske A. van der Jagt, Mathieu Volovici, Victor van Essen, Thomas Polinder, Suzanne Nelson, David Ercole, Ari Stocchetti, Nino Citerio, Giuseppe Peul, Wilco C. Maas, Andrew I. R. Menon, David Krishna Steyerberg, Ewout W. Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
Pályázati támogatás:CENTER-TBI
Egyéb
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4.

001-es BibID:BIBFORM104926
035-os BibID:(Scopus)85058948585 (WOS)000460607500002
Első szerző:Essen, Thomas A. van
Cím:Variation in neurosurgical management of traumatic brain injury : a survey in 68 centers participating in the CENTER-TBI study / Thomas A. van Essen, Hugo F. den Boogert, Maryse C. Cnossen, Godard C. W. de Ruiter, Iain Haitsma, Suzanne Polinder, Ewout W. Steyerberg, David Menon, Andrew I. R. Maas, Hester F. Lingsma, Wilco C. Peul, CENTER-TBI Investigators and Participants
Dátum:2019
ISSN:0001-6268
Megjegyzések:Abstract Background Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decom pressive craniectomy (DC) in raised intracranial pressure (ICP). Results The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Acta Neurochirurgica. - 161 : 3 (2019), p. 435-449. -
További szerzők:Boogert, Hugo F. den Cnossen, Maryse C. Ruiter, Godard C. W. de Haitsma, Iain Polinder, Suzanne Steyerberg, Ewout W. Menon, David Krishna Maas, Andrew I. R. Lingsma, Hester Peul, Wilco C. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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5.

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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6.

001-es BibID:BIBFORM104823
035-os BibID:(WOS)000524528800009 (Scopus)85083076089
Első szerző:Gravesteijn, Benjamin Yaël
Cím:Toward a New Multi-Dimensional Classification of Traumatic Brain Injury : a Collaborative European NeuroTrauma Effectiveness Research for Traumatic Brain Injury Study / Benjamin Gravesteijn, Charlie Sewalt, Ari Ercole, Cecilia Akerlund, David Nelson, Andrew Maas, David Menon, Hester F. Lingsma, Ewout W. Steyerberg, CENTER-TBI collaboration
Dátum:2020
ISSN:0897-7151
Megjegyzések:Traumatic brain injury (TBI) is currently classified as mild, moderate, or severe TBI by trichotomizing the Glasgow Coma Scale (GCS). We aimed to explore directions for a more refined multidimensional classification system. For that purpose, we performed a hypothesis-free cluster analysis in the Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI) database: a European all-severity TBI cohort (n?=?4509). The first building block consisted of key imaging characteristics, summarized using principal component analysis from 12 imaging characteristics. The other building blocks were demographics, clinical severity, secondary insults, and cause of injury. With these building blocks, the patients were clustered into four groups. We applied bootstrap resampling with replacement to study the stability of cluster allocation. The characteristics that predominantly defined the clusters were injury cause, major extracranial injury, and GCS. The clusters consisted of 1451, 1534, 1006, and 518 patients, respectively. The clustering method was quite stable: the proportion of patients staying in one cluster after resampling and reclustering was 97.4% (95% confidence interval [CI]: 85.6?99.9%). These clusters characterized groups of patients with different functional outcomes: from mild to severe, 12%, 19%, 36%, and 58% of patients had unfavorable 6 month outcome. Compared with the mild and the upper intermediate cluster, the lower intermediate and the severe cluster received more key interventions. To conclude, four types of TBI patients may be defined by injury mechanism, presence of major extracranial injury and GCS. Describing patients according to these three characteristics could potentially capture differences in etiology and care pathways better than with GCS only.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Journal Of Neurotrauma. - 37 : 7 (2020), p. 1002-1010. -
További szerzők:Sewalt, Charlie Aletta Ercole, Ari Åkerlund, Cecilia Nelson, David Maas, Andrew I. R. Menon, David Krishna Lingsma, Hester Steyerberg, Ewout W. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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7.

001-es BibID:BIBFORM104936
035-os BibID:(Scopus)85045401878 (WOS)000429979700001 (cikkazonosító)90
Első szerző:Huijben, Jilske A.
Cím:Variation in general supportive and preventive intensive care management of traumatic brain injury : a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study / Jilske A. Huijben, Victor Volovici, Maryse C. Cnossen, Iain K. Haitsma, Nino Stocchetti, Andrew I. R. Maas, David K. Menon, Ari Ercole, Giuseppe Citerio, David Nelson, Suzanne Polinder, Ewout W. Steyerberg, Hester F. Lingsma, Mathieu van der Jagt, CENTER-TBI Investigators and Participants
Dátum:2018
ISSN:1364-8535
Megjegyzések:Abstract Background: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36?40 mmHg (4.8?5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4?4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam wasmostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions: Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Critical Care. - 22 : 1 (2018), p. 1-9. -
További szerzők:Volovici, Victor Cnossen, Maryse C. Haitsma, Iain Stocchetti, Nino Maas, Andrew I. R. Menon, David Krishna Ercole, Ari Citerio, Giuseppe Nelson, David Polinder, Suzanne Steyerberg, Ewout W. Lingsma, Hester Jagt, Mathieu van der Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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8.

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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9.

001-es BibID:BIBFORM066054
Első szerző:Maas, Andrew I. R.
Cím:Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) : a Prospective Longitudinal Observational Study / Andrew I. R. Maas, David K. Menon, Ewout W. Steyerberg, Giuseppe Citerio, Fiona Lecky, Geoffrey T. Manley, Sean Hill, Valerie Legrand, Annina Sorgner, CENTER-TBI Participants and Investigators
Dátum:2015
ISSN:0148-396X
Tárgyszavak:Orvostudományok Egészségtudományok idegen nyelvű folyóiratközlemény külföldi lapban
Megjelenés:Neurosurgery. - 76 : 1 (2015), p. 67-80. -
További szerzők:Menon, David Krishna Steyerberg, Ewout W. Citerio, Giuseppe Lecky, Fiona Manley, Geoffrey T. Hill, Sean Legrand, Valerie Sorgner, Annina Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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10.

001-es BibID:BIBFORM116192
035-os BibID:(Scopus)85168315877 (WOS)000993931100001
Első szerző:Mikolić, Ana
Cím:Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury : A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study / Ana Mikolic, Ewout W. Steyerberg, Suzanne Polinder, Lindsay Wilson, Marina Zeldovich, Nicole von Steinbuechel, Virginia F. J. Newcombe, David K. Menon, Joukjevander Naalt, Hester F. Lingsma, Andrew I. R. Maas, David van Klaveren, CENTER-TBI Participants and Investigators
Dátum:2023
ISSN:0897-7151
Megjegyzések:After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at presentation (Clinical model). The Clinical model was then extended with variables assessed before discharge from hospital: early post-concussion symptoms, CT variables, biomarkers, or all three categories (extended models). In a subset of patients mostly discharged home from the emergency department, the Clinical model was extended with 2-3-week post-concussion and mental health symptoms. Predictors were selected based on Akaike's Information Criterion. Performance of ordinal models was expressed as a concordance index (C) and performance of linear models as proportion of variance explained (R2). Bootstrap validation was used to correct for optimism. We included 2376 mTBI patients with 6-month GOSE and 1605 patients with 6-month RPQ. The Core and Clinical models for GOSE showed moderate discrimination (C = 0.68 95% confidence interval 0.68 to 0.70 and C = 0.70[0.69 to 0.71], respectively) and injury severity was the strongest predictor. The extended models had better discriminative ability (C = 0.71[0.69 to 0.72] with early symptoms; 0.71[0.70 to 0.72] with CT variables or with blood biomarkers; 0.72[0.71 to 0.73] with all three categories). The performance of models for RPQ was modest (R2 = 4% Core; R2 = 9% Clinical), and extensions with early symptoms increased the R2 to 12%. The 2-3-week models had better performance for both outcomes in the subset of participants with these symptoms measured (C = 0.74 [0.71 to 0.78] vs. C = 0.63[0.61 to 0.67] for GOSE; R2 = 37% vs. 6% for RPQ). In conclusion, the models based on variables available before discharge have moderate performance for the prediction of GOSE and poor performance for the prediction of PPCS. Symptoms assessed at 2-3 weeks are required for better predictive ability of both outcomes. The performance of the proposed models should be examined in independent cohorts.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
biomarkers
Glasgow Outcome Scale Extended
mild traumatic brain injury
post-concussion symptoms
predictors
prognostic model
Megjelenés:Journal Of Neurotrauma. - 40 : 15-16 (2023), p. 1651-1670. -
További szerzők:Steyerberg, Ewout W. Polinder, Suzanne Wilson, Lindsay Zeldovich, Marina von Steinbuechel, Nicole Newcombe, Virginia F. J. Menon, David Krishna Naalt, Joukjevander Lingsma, Hester Maas, Andrew I. R. van Klaveren, David Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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DOI
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11.

001-es BibID:BIBFORM072261
Első szerző:Mondello, Stefania
Cím:Blood-based protein biomarkers for the management of traumatic brain injuries in adults presenting to emergency departments with mild brain injury : a living systematic review and meta-analysis / Stefania Mondello, Abayomi Sorinola, Endre Czeiter, Zoltán Vámos, Krisztina Amrein, Anneliese Synnot, Emma Donoghue, János Sándor, Kevin K. W. Wang, Ramon Diaz-Arrastia, Ewout W. Steyerberg, David K. Menon, Andrew I. R. Maas, Andras Buki
Dátum:2021
ISSN:0897-7151 1557-9042
Megjegyzések:Accurate diagnosis of traumatic brain injury (TBI) is critical to effective management and intervention, but can be challenging in patients with mild TBI. A substantial number of studies have reported the use of circulating biomarkers as signatures for TBI, capable of improving diagnostic accuracy and clinical decision-making beyond current practice standards. We performed a systematic review and meta-analysis to comprehensively and critically evaluate the existing body of evidence for the use of blood protein biomarkers (S100B, GFAP, NSE, UCH-L1, Tau and Neurofilament proteins) for diagnosis of intracranial lesions on CT following mild TBI. Effects of potential confounding factors and differential diagnostic performance of the included markers were explored. Furthermore, appropriateness of study design, analysis, quality and demonstration of clinical utility were assessed. Studies published up to October 2016 were identified through a MEDLINE, EMBASE and CINHAL search. Following screening of the identified articles, 26 were selected as relevant. We found that measurement of S100B can help informed decision making in the emergency department possibly reducing resource use, but there is insufficient evidence that any of the other markers is ready for clinical application. Our work pointed out serious problems in the design, analysis and reporting of many of the studies and identified a substantial heterogeneity and research gaps. These findings emphasize the importance of methodologically rigorous studies focused on a biomarker's intended use and defining standardized, validated and reproducible approaches. The living nature of this systematic review, which will summarize key updated information as it becomes available, can inform and guide future implementation of biomarkers in the clinical arena.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Biomarkers
Traumatic
Brain Injury
Diagnosis
Living Systematic review
Meta analysis
Megjelenés:Journal of Neurotrauma. - 38 : 8 (2021), p. 1086-1106. -
További szerzők:Sorinola, Abayomi Czeiter Endre Vámos Zoltán Amrein Krisztina Synnot, Anneliese Donoghue, Emma Sándor János (1966-) (orvos-epidemiológus) Wang, Kevin K. W. Diaz-Arrastia, Ramon Steyerberg, Ewout W. Menon, David Krishna Maas, Andrew I. R. Buki András
Pályázati támogatás:602150
FP7
Internet cím:DOI
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12.

001-es BibID:BIBFORM100333
035-os BibID:(cikkazonosító)113
Első szerző:Sewalt, Charlie Aletta
Cím:Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury : a CENTER TBI study / Sewalt Charlie Aletta, Gravesteijn Benjamin Yaël, Menon David, Lingsma Hester Floor, Maas Andrew I. R., Stocchetti Nino, Venema Esmee, Lecky Fiona E., CENTER-TBI Participants and Investigators
Dátum:2021
ISSN:1757-7241
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Megjelenés:Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - 29 : 1 (2021), p. 1-11. -
További szerzők:Gravesteijn, Benjamin Yaël Menon, David Krishna Lingsma, Hester Maas, Andrew I. R. Stocchetti, Nino Venema, Esmee Lecky, Fiona Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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DOI
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