Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury
Abstract Background We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients b...
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2021
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oai:doaj.org-article:c0d4ec98c53b448e872877c17f9cd9f42021-11-08T10:45:39ZHospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury10.1186/s13049-021-00959-21757-7241https://doaj.org/article/c0d4ec98c53b448e872877c17f9cd9f42021-11-01T00:00:00Zhttps://doi.org/10.1186/s13049-021-00959-2https://doaj.org/toc/1757-7241Abstract Background We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). Methods The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. Results A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. Conclusions In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.Aimone GiugniLorenzo GamberiniGreta CarraraLuca AntigaObou BrissyVirginia BuldiniItalo CalamaiAkos CsomosAlessandra De LucaEnrico FerriJoanne M. FlemingPrimoz GradisekRafael KapsTheodoros KyprianouSilvia LagomarsinoIsaac LazarCostanza MartinoMalgorzata Mikaszewska-SokolewiczAndrea MontisGabor NardaiGiovanni NattinoGiuseppe NattinoGiulia PaciLaila PortolaniNektaria XirouchakiArturo ChieregatoGuido Bertolinifor The CREACTIVE consortiumBMCarticleBrain injuriesTraumaticOutcome assessmentGOS-EProspective studiesRehabilitationMedical emergencies. Critical care. Intensive care. First aidRC86-88.9ENScandinavian Journal of Trauma, Resuscitation and Emergency Medicine, Vol 29, Iss 1, Pp 1-15 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
Brain injuries Traumatic Outcome assessment GOS-E Prospective studies Rehabilitation Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 |
| spellingShingle |
Brain injuries Traumatic Outcome assessment GOS-E Prospective studies Rehabilitation Medical emergencies. Critical care. Intensive care. First aid RC86-88.9 Aimone Giugni Lorenzo Gamberini Greta Carrara Luca Antiga Obou Brissy Virginia Buldini Italo Calamai Akos Csomos Alessandra De Luca Enrico Ferri Joanne M. Fleming Primoz Gradisek Rafael Kaps Theodoros Kyprianou Silvia Lagomarsino Isaac Lazar Costanza Martino Malgorzata Mikaszewska-Sokolewicz Andrea Montis Gabor Nardai Giovanni Nattino Giuseppe Nattino Giulia Paci Laila Portolani Nektaria Xirouchaki Arturo Chieregato Guido Bertolini for The CREACTIVE consortium Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| description |
Abstract Background We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). Methods The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. Results A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. Conclusions In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs. |
| format |
article |
| author |
Aimone Giugni Lorenzo Gamberini Greta Carrara Luca Antiga Obou Brissy Virginia Buldini Italo Calamai Akos Csomos Alessandra De Luca Enrico Ferri Joanne M. Fleming Primoz Gradisek Rafael Kaps Theodoros Kyprianou Silvia Lagomarsino Isaac Lazar Costanza Martino Malgorzata Mikaszewska-Sokolewicz Andrea Montis Gabor Nardai Giovanni Nattino Giuseppe Nattino Giulia Paci Laila Portolani Nektaria Xirouchaki Arturo Chieregato Guido Bertolini for The CREACTIVE consortium |
| author_facet |
Aimone Giugni Lorenzo Gamberini Greta Carrara Luca Antiga Obou Brissy Virginia Buldini Italo Calamai Akos Csomos Alessandra De Luca Enrico Ferri Joanne M. Fleming Primoz Gradisek Rafael Kaps Theodoros Kyprianou Silvia Lagomarsino Isaac Lazar Costanza Martino Malgorzata Mikaszewska-Sokolewicz Andrea Montis Gabor Nardai Giovanni Nattino Giuseppe Nattino Giulia Paci Laila Portolani Nektaria Xirouchaki Arturo Chieregato Guido Bertolini for The CREACTIVE consortium |
| author_sort |
Aimone Giugni |
| title |
Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| title_short |
Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| title_full |
Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| title_fullStr |
Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| title_full_unstemmed |
Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| title_sort |
hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury |
| publisher |
BMC |
| publishDate |
2021 |
| url |
https://doaj.org/article/c0d4ec98c53b448e872877c17f9cd9f4 |
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