Abstract

Background

Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients.

Methods

Patients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively.

Results

A total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78–1.69), nor with survival at discharge (1.05, 0.58–1.90).

Conclusions

Across Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation.

Details

Title
Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study
Author
Sewalt, Charlie Aletta 1   VIAFID ORCID Logo  ; Gravesteijn, Benjamin Yaël 2 ; Menon, David 3 ; Lingsma, Hester Floor 1 ; Maas, Andrew I. R. 4 ; Stocchetti, Nino 5 ; Venema, Esmee 6 ; Lecky, Fiona E. 7 ; Åkerlund, Cecilia; Amrein, Krisztina; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Antoni, Anna; Audibert, Gérard; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, Ronald; Barzó, Pál; Beauvais, Romuald; Beer, Ronny; Bellander, Bo-Michael; Belli, Antonio; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Blaabjerg, Morten; Bragge, Peter; Brazinova, Alexandra; Brinck, Vibeke; Brooker, Joanne; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo; Carbonara, Marco; Chevallard, Giorgio; Chieregato, Arturo; Citerio, Giuseppe; Cnossen, Maryse; Coburn, Mark; Coles, Jonathan; Cooper, D. Jamie; Correia, Marta; Čović, Amra; Curry, Nicola; Czeiter, Endre; Czosnyka, Marek; Dahyot-Fizelier, Claire; Dawes, Helen; De Keyser, Véronique; Degos, Vincent; Corte, Francesco Della; Boogert, Hugo den; Depreitere, Bart; Đilvesi, Đula; Dixit, Abhishek; Donoghue, Emma; Dreier, Jens; Dulière, Guy-Loup; Ercole, Ari; Esser, Patrick; Ezer, Erzsébet; Fabricius, Martin; Feigin, Valery L.; Foks, Kelly; Frisvold, Shirin; Furmanov, Alex; Gagliardo, Pablo; Galanaud, Damien; Gantner, Dashiell; Gao, Guoyi; George, Pradeep; Ghuysen, Alexandre; Giga, Lelde; Glocker, Ben; Golubovic, Jagoš; Gomez, Pedro A.; Gratz, Johannes; Gravesteijn, Benjamin; Grossi, Francesca; Gruen, Russell L.; Gupta, Deepak; Haagsma, Juanita A.; Haitsma, Iain; Helbok, Raimund; Helseth, Eirik; Horton, Lindsay; Huijben, Jilske; Hutchinson, Peter J.; Jacobs, Bram; Jankowski, Stefan; Jarrett, Mike; Jiang, Ji-yao; Jones, Kelly; Karan, Mladen; Kolias, Angelos G.; Kompanje, Erwin; Kondziella, Daniel; Koraropoulos, Evgenios; Koskinen, Lars-Owe; Kovács, Noémi; Lagares, Alfonso; Lanyon, Linda; Laureys, Steven; Lecky, Fiona; Lefering, Rolf; Legrand, Valerie; Lejeune, Aurelie; Levi, Leon; Lightfoot, Roger; Lingsma, Hester; Castaño-León, Ana M.; Maegele, Marc; Majdan, Marek; Manara, Alex; Manley, Geoffrey; Martino, Costanza; Maréchal, Hugues; Mattern, Julia; McMahon, Catherine; Melegh, Béla; Menovsky, Tomas; Mulazzi, Davide; Muraleedharan, Visakh; Murray, Lynnette; Nair, Nandesh; Negru, Ancuta; Nelson, David; Newcombe, Virginia; Nieboer, Daan; Noirhomme, Quentin; Nyirádi, József; Olubukola, Otesile; Oresic, Matej; Ortolano, Fabrizio; Palotie, Aarno; Parizel, Paul M.; Payen, Jean-François; Perera, Natascha; Perlbarg, Vincent; Persona, Paolo; Peul, Wilco; Piippo-Karjalainen, Anna; Pirinen, Matti; Ples, Horia; Polinder, Suzanne; Pomposo, Inigo; Posti, Jussi P.; Puybasset, Louis; Radoi, Andreea; Ragauskas, Arminas; Raj, Rahul; Rambadagalla, Malinka; Real, Ruben; Rhodes, Jonathan; Richardson, Sylvia; Richter, Sophie; Ripatti, Samuli; Rocka, Saulius; Roe, Cecilie; Roise, Olav; Rosand, Jonathan; Rosenfeld, Jeffrey V.; Rosenlund, Christina; Rosenthal, Guy; Rossaint, Rolf; Rossi, Sandra; Rueckert, Daniel; Rusnák, Martin; Sahuquillo, Juan; Sakowitz, Oliver; Sanchez-Porras, Renan; Sandor, Janos; Schäfer, Nadine; Schmidt, Silke; Schoechl, Herbert; Schoonman, Guus; Schou, Rico Frederik; Schwendenwein, Elisabeth; Sewalt, Charlie; Skandsen, Toril; Smielewski, Peter; Sorinola, Abayomi; Stamatakis, Emmanuel; Stanworth, Simon; Kowark, Ana; Stevens, Robert; Stewart, William; Steyerberg, Ewout W.; Sundström, Nina; Synnot, Anneliese; Takala, Riikka; Tamás, Viktória; Tamosuitis, Tomas; Taylor, Mark Steven; Ao, Braden Te; Tenovuo, Olli; Theadom, Alice; Thomas, Matt; Tibboel, Dick; Timmers, Marjolein; Tolias, Christos; Trapani, Tony; Tudora, Cristina Maria; Vajkoczy, Peter; Vallance, Shirley; Valeinis, Egils; Vámos, Zoltán; Van der Steen, Gregory; van der Naalt, Joukje; van Dijck, Jeroen T. J. M.; van Essen, Thomas A.; Van Hecke, Wim; van Heugten, Caroline; Van Praag, Dominique; Vyvere, Thijs Vande; Vanhaudenhuyse, Audrey; van Wijk, Roel P. J.; Vargiolu, Alessia; Vega, Emmanuel; Velt, Kimberley; Verheyden, Jan; Vespa, Paul M.; Vik, Anne; Vilcinis, Rimantas; Volovici, Victor; von Steinbüchel, Nicole; Voormolen, Daphne; Vulekovic, Petar; Wang, Kevin K. W.; Wiegers, Eveline; Williams, Guy; Wilson, Lindsay; Winzeck, Stefan; Wolf, Stefan; Yang, Zhihui; Ylén, Peter; Younsi, Alexander; Zeiler, Frederik A.; Zelinkova, Veronika; Ziverte, Agate; Zoerle, Tommaso

1  Erasmus MC Medical Center, Department of Public Health, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
2  Erasmus MC Medical Center, Department of Public Health, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X); Erasmus MC Medical Center, Department of Anesthesiology, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
3  University of Cambridge, Division of Anaesthesia, Addenbrooke’s Hospital, Cambridge, UK (GRID:grid.5335.0) (ISNI:0000000121885934) 
4  Antwerp University Hospital, and University of Antwerp, Department of Neurosurgery, Edegem, Belgium (GRID:grid.411414.5) (ISNI:0000 0004 0626 3418) 
5  Milan University, and Neuroscience ICU, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Milan, Italy (GRID:grid.411414.5) 
6  Erasmus MC Medical Center, Department of Public Health, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X); Erasmus MC Medical Center, Department of Neurology, Rotterdam, The Netherlands (GRID:grid.5645.2) (ISNI:000000040459992X) 
7  University of Sheffield, Center for Urgent and Emergency Care Research (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), Sheffield, UK (GRID:grid.11835.3e) (ISNI:0000 0004 1936 9262) 
Pages
113
Publication year
2021
Publication date
Dec 2021
Publisher
Springer Nature B.V.
ISSN
17577241
e-ISSN
15007480
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13049-021-00930-1
ProQuest document ID
2729547933
Copyright
© The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.