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001-es BibID:	BIBFORM104837
035-os BibID:	(Scopus)85088991849 (WOS)000572673400042
Első szerző:	Gravesteijn, Benjamin Yaël
Cím:	Tracheal intubation in traumatic brain injury : a multicentre prospective observational study / Benjamin Yael Gravesteijn, Charlie Aletta Sewalt, Daan Nieboer, David Krishna Menon, Andrew Maas, Fiona Lecky, Markus Klimek, Hester Floor Lingsma, CENTERTBI collaboratorsy
Dátum:	2020
ISSN:	0007-0912
Megjegyzések:	Abstract Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n?4509). For prehospital intubation, we excluded self- presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio?1.01; 95% confidence interval, 0.79e1.28; P?0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio?0.86; 95% confidence interval, 0.65e1.13; P?0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P?0.009 and P?0.02, respectively), whereas in- hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P?0.01): in- hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221
Tárgyszavak:	Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban folyóiratcikk effectiveness Europe neurological outcome prehospital tracheal intubation traumatic brain injury
Megjelenés:	British Journal Of Anaesthesia. - 125 : 4 (2020), p. 505-517. -
További szerzők:	Sewalt, Charlie Aletta Nieboer, Daan Menon, David Krishna Maas, Andrew I. R. Lecky, Fiona Klimek, Markus Lingsma, Hester Sándor János (1966-) (orvos-epidemiológus) CENTER-TBI collaborators
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001-es BibID:	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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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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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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