Background: No large international studies have investigated care transitions during or following acute hospitalisations for traumatic brain injury (TBI). Objectives: To characterise various TBI-care pathways and the number of associated transitions during the first six months after TBI, and to assess the impact of these on functional TBI outcome controlled for demographic and injury-related factors. Methods: A cohort study of patients with TBI admitted to a variety of trauma centres were enrolled in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Number of transitions and specific care pathways were identified. Multiple logistic regression analyses were used to assess impact of number of transitions and care pathways on functional outcome six months post-injury as assessed by Glasgow Outcome Scale- Extended (GOSE). Results: 3133 patients survived the acute TBI-care pathway, and had at least one documented in-hospital transition at six-months follow-up. The median number of transitions was 3 (IQR 2-3). The number of transitions did not predict functional outcome at six months (odds ratio 1.08, p .063). 378 different care pathways were identified. Eight pathways were identical for at least 100 patients and characterized as “common pathways”. Five of these common care pathways were predictive of better functional outcomes at six months, while the remaining three pathways were unrelated to outcome. In both models increased age, violence as the cause of injury, pre-injury presence of systemic disease, both intracranial and overall injury severity, and regions of Southern/Eastern Europe were associated with unfavourable functional outcomes at six months. Conclusion: High numbers of different and complex care pathways were found, particularly in TBI patients with severe injuries. This high number and variety of care pathway possibilities indicates a need for standardisation and development of “common data elements for TBI care pathways” for future studies.
Borgen, Ida M.H.Røe, CecilieBrunborg, CathrineTenovuo, OlliPhilippe AzouviDawes, HelenMajdan, MarekRanta, JukkaRusnak, MartinWiegers, Eveline J.A.Tverdal, CathrineJacob, LouisCogné, MélanieSteinbuechel, Nicole vonAndelic, NadaCENTER-TBI participants and investigators
Department of Sport, Health Sciences and Social Work
Year of publication: 2021Date of RADAR deposit: 2020-12-03