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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
Internet cím:	Szerző által megadott URL DOI Intézményi repozitóriumban (DEA) tárolt változat
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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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