Care transitions in the first 6months following traumatic brain injury: Lessons from the CENTER-TBI study.

Brain Injuries, Traumatic Cohort Studies Glasgow Outcome Scale Hospitalization Humans Infant Patient Transfer

Journal

Annals of physical and rehabilitation medicine
ISSN: 1877-0665
Titre abrégé: Ann Phys Rehabil Med
Pays: Netherlands
ID NLM: 101502773

Informations de publication

Date de publication:
Nov 2021
Historique:
received: 08 07 2020
revised: 26 10 2020
accepted: 29 10 2020
pubmed: 28 11 2020
medline: 21 12 2021
entrez: 27 11 2020
Statut: ppublish

Résumé

No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI). 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. 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). 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. 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. ClinicalTrials.gov NCT02210221.

Sections du résumé

BACKGROUND BACKGROUND
No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI).
OBJECTIVES OBJECTIVE
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 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 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 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 BACKGROUND
ClinicalTrials.gov NCT02210221.

Identifiants

DOI: 10.1016/j.rehab.2020.10.009 PMID: 33246186
pubmed: 33246186
pii: S1877-0657(20)30217-7
doi: 10.1016/j.rehab.2020.10.009
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02210221']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

101458

Informations de copyright

Copyright © 2020 The Authors. Published by Elsevier Masson SAS.. All rights reserved.

Auteurs

Ida M H Borgen (IMH)

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway. Electronic address: idmbor@ous-hf.no.

Cecilie Røe (C)

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Cathrine Brunborg (C)

Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.

Olli Tenovuo (O)

Turku Brain Injury Centre, University of Turku and Turku University Hospital, Turku, Finland.

Philippe Azouvi (P)

AP-HP, GH Paris-Saclay, Hopital Raymond Poincaré, Garches and Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.

Helen Dawes (H)

Oxford Brookes University, health and life sciences, Oxford, UK.

Marek Majdan (M)

Trnava University, Faculty of Health Sciences and Social Work, Department of Public Health, Institute for Global Health and Epidemiology, Slovakia.

Jukka Ranta (J)

VTT Technical Research Centre of Finland Ltd, Finland.

Martin Rusnak (M)

Trnava University, Faculty of Health Sciences and Social Work, Department of Public Health, Institute for Global Health and Epidemiology, Slovakia.

Eveline J A Wiegers (EJA)

Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.

Cathrine Tverdal (C)

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.

Louis Jacob (L)

Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.

Mélanie Cogné (M)

University Hospital of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.

Nicole von Steinbuechel (N)

Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Germany.

Nada Andelic (N)

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female

Evaluation of Low-Value Services Across Major Medicare Advantage Insurers and Traditional Medicare.

Ciara Duggan, Adam L Beckman, Ishani Ganguli et al.
1.00
Humans United States Aged Cross-Sectional Studies Medicare Part C

Effectiveness of Virtual Yoga for Chronic Low Back Pain: A Randomized Clinical Trial.

Hallie Tankha, Devyn Gaskins, Amanda Shallcross et al.
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH

questionsmedicales.fr › Plaies et blessures › Traumatismes du système nerveux › Traumatismes cranioencéphaliques › Lésions encéphaliques › Lésions traumatiques de l'encéphale › Care transitions in the first 6months...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Care transitions in the first 6months...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Échelle de suivi de Glasgow › Care transitions in the first 6months...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Hospitalisation › Care transitions in the first 6months...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Care transitions in the first 6months...
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Care transitions in the first 6months...
questionsmedicales.fr › Administration des services de santé › Gestion des soins aux patients › Services de santé polyvalents › Soins de santé primaires › Continuité des soins › Transfert de patient › Care transitions in the first 6months...