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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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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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