A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
Characteristics, management and outcomes of patients with severe traumatic brain injury in Victoria, Australia compared to United Kingdom and Europe: A comparison between two harmonised prospective cohort studies
Tekijät: Wiegers Eveline JA, Trapani Tony, Gabbe Belinda J, Gantner Dashiell, Lecky Fiona, Maas Andrew IR, Menon David K, Murray Lynette, Rosenfeld Jeffrey V, Vallance Shirley, Lingsma Hester F, Steyerberg Ewout W, Cooper D James; and the CENTER-TBI and OzENTER-TBI investigators and participants
Kustantaja: ELSEVIER SCI LTD
Julkaisuvuosi: 2021
Journal: Injury
Tietokannassa oleva lehden nimi: INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED
Lehden akronyymi: INJURY
Vuosikerta: 52
Aloitussivu: 2576
Lopetussivu: 2587
Sivujen määrä: 12
ISSN: 0020-1383
eISSN: 1879-0267
DOI: https://doi.org/10.1016/j.injury.2021.04.033
Verkko-osoite: https://www.sciencedirect.com/science/article/pii/S0020138321003429?via%3Dihub
Objective: The aim of this manuscript is to compare characteristics, management, and outcomes of patients with severe Traumatic Brain Injury (TBI) between Australia, the United Kingdom (UK) and Europe.
Methods: We enrolled patients with severe TBI in Victoria, Australia (OzENTER-TBI), in the UK and Europe (CENTER-TBI) from 2015 to 2017. Main outcome measures were mortality and unfavourable outcome (Glasgow Outcome Scale Extended < 5) 6 months after injury. Expected outcomes were compared according to the IMPACT-CT prognostic model, with observed to expected (O/E) ratios and 95% confidence intervals.
Results: We included 107 patients from Australia, 171 from UK, and 596 from Europe. Compared to the UK and Europe, patients in Australia were younger (median 32 vs 44 vs 44 years), a larger proportion had secondary brain insults including hypotension (30% vs 17% vs 21%) and a larger proportion received ICP monitoring (75% vs 74% vs 58%). Hospital length of stay was shorter in Australia than in the UK (median: 17 vs 23 vs 16 days), and a higher proportion of patients were discharged to a rehabilitation unit in Australia than in the UK and Europe (64% vs 26% vs 28%). Mortality overall was lower than expected (27% vs 35%, O/E ratio 0.77 [95% CI: 0.64 - 0.87]. O/E ratios were comparable between regions for mortality in Australia 0.86 [95% CI: 0.49-1.23] vs UK 0.82 [0.51-1.15] vs Europe 0.76 [0.60-0.87]). Unfavourable outcome rates overall were in line with historic expectations (O/E ratio 1.32 [0.96-1.68] vs 1.13 [0.841.42] vs 0.96 [0.85-1.09]).
Conclusions: There are major differences in case-mix between Australia, UK, and Europe; Australian patients are younger and have a higher rate of secondary brain insults. Despite some differences in management and discharge policies, mortality was less than expected overall, and did not differ between regions. Functional outcomes were similar between regions, but worse than expected, emphasizing the need to improve treatment for patients with severe TBI. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
