Patients with traumatic brain injury admitted to intensive care units are older and often less severe than in previous studies. Substantial between-center variation exists in ICU admission and treatment policies across Europe. |
Introduction
Methods
CENTER-TBI study
ICU population and data collection
ICP and ICP-lowering treatments
Outcome
Statistical analysis
Results
Patient characteristics
Total 2138 | Short stay 636 | Long stay 1372 | Early deaths 128 | p value | |
---|---|---|---|---|---|
Age (median (IQR)) | 49 (29–65) | 48 (28–64) | 49 (29–64) | 62 (40–75) | < 0.001 |
≥ 65 years | 552/2138 (26%) | 153/636 (24%) | 337/1372 (25%) | 62/128 (48%) | < 0.001 |
≥ 80 years | 94/2138(4.4%) | 29/636 (4.6%) | 52/1372 (3.8%) | 13/128 (10%) | 0.003 |
Male sex | 1562/2138 (73%) | 443/636 (70%) | 1023/1372 (75%) | 94/128 (73%) | 0.07 |
Severity TBI | < 0.001 | ||||
Mild | 720/2009 (36%) | 394/607 (65%) | 319/1285 (25%) | 6/116 (5.2%) | |
Moderate | 328/2009 (16%) | 107/607 (18%) | 213/1285 (17%) | 8/116 (6.9%) | |
Severe | 961/2009 (48%) | 106/607 (18%) | 753/1285 (59%) | 102/116 (88%) | |
Pupillary reactivity | < 0.001 | ||||
Both reacting | 1636/2016 (81%) | 564/606 (93%) | 1040/1287 (81%) | 31/122 (25%) | |
Both unreacting | 246/2016 (12%) | 16/606 (2.6%) | 150/1287 (12%) | 80/122 (65%) | |
One reacting | 134/2016 (6.6%) | 26/606 (4.3%) | 97/1287 (7.5%) | 11/122 (9%) | |
Hypoxia | 266/1981 (13%) | 38/593 (6.4%) | 191/1266 (15%) | 37/121 (31%) | < 0.001 |
Hypotension | 267/1992 (13%) | 36/595 (6.1%) | 189/1274 (15%) | 42/122 (34%) | < 0.001 |
ISS [median (IQR)] | 29 (25–41) | 24 (16–29) | 34 (25–43) | 58 (28–75) | < 0.001 |
Any major extracranial injury (AIS ≥ 3) | 1174/2138 (55%) | 283/636 (45%) | 823/1372 (60%) | 67/128 (53%) | < 0.001 |
CT characteristics | |||||
Marshall CT classification | < 0.001 | ||||
I | 204/1854 (11%) | 110/566 (19%) | 90/1179 (7.6%) | 3/108 (2.8%) | |
II | 889/1854 (48%) | 330/566 (58%) | 553/1179 (47%) | 6/108 (5.6%) | |
III | 152/1854 (8.2%) | 19/566 (3.4%) | 105/1179 (8.9%) | 28/108 (26%) | |
IV | 28/1854 (1.5%) | 4/566 (0.7%) | 17/1179 (1.4%) | 7/108 (6.5%) | |
V/VI | 581/1854 (31%) | 103/566 (18%) | 414/1179 (35%) | 64/108 (59%) | |
Epidural hematoma | 369/1854 (20%) | 120/566 (21%) | 234/1179 (20%) | 15/108 (14%) | 0.22 |
tSAH | 1347/1854 (73%) | 318/566 (56%) | 930/1179 (79%) | 99/108 (92%) | < 0.001 |
Contusion | 1032/1854 (56%) | 244/566 (43%) | 730/1179 (62%) | 58/108 (54%) | < 0.001 |
Acute subdural hematoma | 911/1854 (49%) | 192/566 (34%) | 633/1179 (54%) | 86/108 (80%) | < 0.001 |
Midline shift | 404/1854 (22%) | 77/566 (14%) | 281/1179 (24%) | 54/108 (50%) | < 0.001 |
Basal cistern absent or compressed | 586/1854 (32%) | 81/566 (14%) | 415/1179 (35%) | 94/108 (87%) | < 0.001 |
Monitoring and treatment
Complications and outcome
Total 2138 | Short stay 636 | Long stay 1372 | p value | |
---|---|---|---|---|
Outcomes | ||||
6-month mortality | 394/1846 (21%) | 29/531 (5.5%) | 237/1187 (20%) | < 0.001 |
6-month unfavorable outcome (GOSE < 5) | 795/1846 (43%) | 77/531 (15%) | 590/1187 (50%) | < 0.001 |
Hospital length of stay in days (median (IQR)) | 11 (3.4–26) | 6.3 (3–11) | 18 (7.7–35) | < 0.001 |
Discharge location from ICU | < 0.001 | |||
General ward | 1102/1840 (60%) | 486/623 (78%) | 616/1216 (51%) | |
Home | 15/1840 (0.8%) | 11/623 (1.8%) | 4/1216 (0.3%) | |
Nursing home | 4/1840 (0.2%) | 2/623 (0.3%) | 2/1216 (0.2%) | |
Other | 36/1840 (2%) | 5/623 (0.8%) | 30/1216 (2.4%) | |
Other hospital | 201/1840 (11%) | 27/623 (4.3%) | 174/1216 (14%) | |
Other ICU | 43/1840 (2.3%) | 3/623 (0.5%) | 40/1216 (3.3%) | |
Rehab unit | 98/1840 (5.3%) | 3/623 (0.5%) | 95/1216 (7.8%) | |
Step-down/high-care unit | 341/1840 (19%) | 86/623 (13.8%) | 255/1216 (21%) | |
Complications at the ICU | ||||
Ventilator acquired pneumonia | 280/2090 (13%) | 3/616 (0.5%) | 276/1347 (21%) | < 0.001 |
Cardiovascular complications | 155/2091 (7.4%) | 9/616 (1.5%) | 125/1348 (9.3%) | < 0.001 |
Meningitis | 49/2090 (2.3%) | 0/616 (0%) | 48/1347 (3.6%) | < 0.001 |
Seizures | 121/2089 (5.8%) | 17/616 (2.8%) | 99/1346 (7.4%) | < 0.001 |