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1.

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: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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3.

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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4.

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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5.

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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6.

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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7.

001-es BibID:BIBFORM107454
035-os BibID:(cikkazonosító)36 (scopus)85084535573 (wos)000535606600002
Első szerző:Timmers, Marjolein
Cím:How do 66 European institutional review boards approve one protocol for an international prospective observational study on traumatic brain injury? Experiences from the CENTER-TBI study / Timmers, Marjolein; van Dijck, Jeroen T. J. M.; van Wijk, Roel P. J.; Legrand, Valerie; van Veen, Ernest; Maas, Andrew I. R.; Menon, David K.; Citerio, Giuseppe; Stocchetti, Nino; Kompanje, Erwin J. O., CENTER-TBI investigators and participants
Dátum:2020
ISSN:1472-6939
Megjegyzések:Background: The European Union (EU) aims to optimize patient protection and efficiency of health-care research by harmonizing procedures across Member States. Nonetheless, further improvements are required to increase multicenter research efficiency. We investigated IRB procedures in a large prospective European multicenter study on traumatic brain injury (TBI), aiming to inform and stimulate initiatives to improve efficiency. Methods: We reviewed relevant documents regarding IRB submission and IRB approval from European neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Documents included detailed information on IRB procedures and the duration from IRB submission until approval(s). They were translated and analyzed to determine the level of harmonization of IRB procedures within Europe. Results: From 18 countries, 66 centers provided the requested documents. The primary IRB review was conducted centrally (N = 11, 61%) or locally (N = 7, 39%) and primary IRB approval was obtained after one (N = 8, 44%), two (N = 6, 33%) or three (N = 4, 23%) review rounds with a median duration of respectively 50 and 98 days until primary IRB approval. Additional IRB approval was required in 55% of countries and could increase duration to 535 days. Total duration from submission until required IRB approval was obtained was 114 days (IQR 75?224) and appeared to be shorter after submission to local IRBs compared to central IRBs (50 vs. 138 days, p = 0.0074). Conclusion: We found variation in IRB procedures between and within European countries. There were differences in submission and approval requirements, number of review rounds and total duration. Research collaborations could benefit from the implementation of more uniform legislation and regulation while acknowledging local cultural habits and moral values between countries.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Research ethic committees
European Union
Health-care research
CENTER-TBI
Harmonization
Megjelenés:BMC Medical Ethics. - 21 : 1 (2020), p. 1-14. -
További szerzők:van Dijck, Jeroen T. J. M. van Wijk, Roel P. J. Legrand, Valerie van Veen, Ernest Maas, Andrew I. R. Menon, David Krishna Citerio, Giuseppe Stocchetti, Nino Kompanje, Erwin J. O. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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Intézményi repozitóriumban (DEA) tárolt változat
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8.

001-es BibID:BIBFORM107421
035-os BibID:(scopus)85117210103 (wos)000681565200001
Első szerző:van Veen, Ernest
Cím:Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients : a CENTER-TBI study / van Veen Ernest, van der Jagt Mathieu, Citerio Giuseppe, Stocchetti Nino, Gommers Diederik, Burdorf Alex, Menon David K., Maas Andrew I. R., Kompanje Erwin J. O., Lingsma Hester F., CENTER-TBI investigators and participants
Dátum:2021
ISSN:0342-4642
Megjegyzések:Background: In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in inten sive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the pos sibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). Methods: The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (<72 h after injury) versus later (?72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed efects) logistic regression. Results: A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n=267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confdence interval (CI) 1.3?12.4) or two unreactive pupils (OR 5.8, CI 2.6?13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41=1.1, CI 1.0?1.1). Timing of WLSM was not signifcantly associated with region or center. Conclusion: WLSM occurs early in half of the patients, mostly in patients with severe TBI afecting brainstem refexes who were severely injured. We found no regional or center infuences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulflling prophecy requires further research and argues for reluctance to insti tute WLSM early in case of any doubt on prognosis.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
traumatic brain injury
Megjelenés:Intensive Care Medicine. - 47 : 10 (2021), p. 1115-1129. -
További szerzők:van der Jagt, Mathieu Citerio, Giuseppe Stocchetti, Nino Gommers, Diederik Burdorf, Alex Menon, David Krishna Maas, Andrew I. R. Kompanje, Erwin J. O. Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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Intézményi repozitóriumban (DEA) tárolt változat
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9.

001-es BibID:BIBFORM107438
035-os BibID:(scopus)85085505275 (wos)000581019400002
Első szerző:van Wijk, Roel P. J.
Cím:Informed consent procedures in patients with an acute inability to provide informed consent : Policy and practice in the CENTER-TBI study / van Wijk Roel P. J., van Dijck Jeroen T. J. M., Timmers Marjolein, van Veen Ernest, Citerio Giuseppe, Lingsma Hester F., Maas Andrew I. R., Menon David K., Peul Wilco C., Stocchetti Nino, Kompanje Erwin J. O., CENTER-TBI investigators and participants
Dátum:2020
ISSN:0883-9441
Megjegyzések:Purpose: Enrolling traumatic brain injury (TBI) patients with an inability to provide informed consent in research is challenging. Alternatives to patient consent are not sufficiently embedded in European and national legislation, which allows procedural variation and bias. We aimed to quantify variations in informed consent policy and prac- tice. Methods: Variation was explored in the CENTER-TBI study. Policies were reported by using a questionnaire and national legislation. Data on used informed consent procedures were available for 4498 patients from 57 centres across 17 European countries. Results: Variation in the use of informed consent procedures was found between and within EU member states. Proxy informed consent (N = 1377;64%) was the most frequently used type of consent in the ICU, followed by patient informed consent (N = 426;20%) and deferred consent (N = 334;16%). Deferred consent was only ac- tively used in 15 centres (26%), although it was considered valid in 47 centres (82%). Conclusions: Alternatives to patient consent are essential for TBI research. While there seems to be concordance amongst national legislations, there is regional variability in institutional practices with respect to the use of dif- ferent informed consent procedures. Variation could be caused by several reasons, including inconsistencies in clear legislation or knowledge of such legislation amongst researchers.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Informed consent
European Union Ethics
Megjelenés:Journal Of Critical Care. - 59 (2020), p. 6-15. -
További szerzők:van Dijck, Jeroen T. J. M. Timmers, Marjolein van Veen, Ernest Citerio, Giuseppe Lingsma, Hester Maas, Andrew I. R. Menon, David Krishna Peul, Wilco C. Stocchetti, Nino Kompanje, Erwin J. O. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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DOI
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10.

001-es BibID:BIBFORM107505
035-os BibID:(WOS)000450478400002 (Scopus)85056714365 (cikkazonosító)306
Első szerző:Veen, Ernest van
Cím:Brain death and postmortem organ donation : report of a questionnaire from the CENTER-TBI study / Ernest van Veen, Mathieu van der Jagt, Maryse C. Cnossen, Andrew I. R. Maas, Inez D. de Beaufort, David K. Menon, Giuseppe Citerio, Nino Stocchetti, Wim J. R. Rietdijk, Jeroen T. J. M. van Dijck, Erwin J. O. Kompanje, CENTER-TBI investigators and participants
Dátum:2018
ISSN:1364-8535
Megjegyzések:Abstract Background: We aimed to investigate the extent of the agreement on practices around brain death and postmortem organ donation. Methods: Investigators from 67 Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study centers completed several questionnaires (response rate: 99%). Results: Regarding practices around brain death, we found agreement on the clinical evaluation (prerequisites and neurological assessment) for brain death determination (BDD) in 100% of the centers. However, ancillary tests were required for BDD in 64% of the centers. BDD for nondonor patients was deemed mandatory in 18% of the centers before withdrawing life-sustaining measures (LSM). Also, practices around postmortem organ donation varied. Organ donation after circulatory arrest was forbidden in 45% of the centers. When withdrawal of LSM was contemplated, in 67% of centers the patients with a ventricular drain in situ had this removed, either sometimes or all of the time. Conclusions: This study showed both agreement and some regional differences regarding practices around brain death and postmortem organ donation. We hope our results help quantify and understand potential differences, and provide impetus for current dialogs toward further harmonization of practices around brain death and postmortem organ donation
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
folyóiratcikk
Traumatic brain injury
Brain death
Ethics
Postmortem organ donation
Withdrawing life-sustaining measures
Ventricular drainage
Megjelenés:Critical Care. - 22 : 1 (2018), p. 1-11. -
További szerzők:Jagt, Mathieu van der Cnossen, Maryse C. Maas, Andrew I. R. Beaufort, Inez D. de Menon, David Krishna Citerio, Giuseppe Stocchetti, Nino Rietdijk, Wim J. R. Dijck, Jeroen T. J. M. van Kompanje, Erwin J. O. Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI Participants and Investigators
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Intézményi repozitóriumban (DEA) tárolt változat
Borító:

11.

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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