Care transitions in the first 6 months following traumatic brain injury: Lessons from the CENTER-TBI study - 14/12/21
, Cecilie Røe a, c, Cathrine Brunborg d, Olli Tenovuo e, Philippe Azouvi f, Helen Dawes g, Marek Majdan h, Jukka Ranta i, Martin Rusnak h, Eveline J.A. Wiegers j, Cathrine Tverdal a, Louis Jacob k, Mélanie Cogné l, Nicole von Steinbuechel m, Nada Andelic a, nCENTER-TBI participants investigators
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Highlights |
• | This is the first large international study of care transitions after traumatic brain injury (TBI). |
• | Patient care pathways were diverse and complex, particularly for severe TBI. |
• | Severe TBI and major overall trauma lead to more in-hospital transitions. |
• | A standardization of care pathways for TBI is needed. |
Abstract |
Background |
No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI).
Objectives |
To characterise various TBI-care pathways and the number of associated transitions during the first 6 months after TBI and to assess the impact of these on functional TBI outcome controlled for demographic and injury-related factors.
Methods |
This was a cohort study of patients with TBI admitted to various trauma centres 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 the impact of number of transitions and care pathways on functional outcome at 6 months post-injury as assessed by the Glasgow Outcome Scale-Extended (GOSE).
Results |
In total, 3133 patients survived the acute TBI-care pathway and had at least one documented in-hospital transition at 6-month follow-up. The median number of transitions was 3 (interquartile range 2–3). The number of transitions did not predict functional outcome at 6 months (odds ratio 1.08, 95% confidence interval 1.09–1.18; P=0.063). A total of 378 different care pathways were identified; 8 were identical for at least 100 patients and characterized as “common pathways”. Five of these common care pathways predicted better functional outcomes at 6 months, and the remaining 3 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 6 months.
Conclusions |
A high number of different and complex care pathways was found for patients with TBI, particularly those 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.
Study registration |
ClinicalTrials.gov NCT02210221.
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Vol 64 - N° 6
Article 101458- novembre 2021 Retour au numéro
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