Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Laila Portolani¹  Costanza Martino¹  Italo Calamai²  Virginia Buldini³  Enrico Ferri³  Lorenzo Gamberini³  Aimone Giugni³  Malgorzata Mikaszewska-Sokolewicz⁴  Primoz Gradisek⁵  Gabor Nardai⁶  Andrea Montis⁷  Rafael Kaps⁸  Akos Csomos⁹  Giuseppe Nattino^1,10  Guido Bertolini^1,11  Giovanni Nattino^1,11  Joanne M. Fleming^1,11  Greta Carrara^1,11  Obou Brissy^1,11  Giulia Paci^1,11  Silvia Lagomarsino^1,12  Alessandra De Luca^1,12  Arturo Chieregato^1,13  Luca Antiga^1,14  Isaac Lazar^1,15  Nektaria Xirouchaki^1,16  Theodoros Kyprianou^1,17 

[1] Anesthesia and Intensive Care Unit, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy;Anesthesia and Intensive Care Unit, AUSL Toscana Centro, San Giuseppe Hospital, Empoli, Florence, Italy;Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy;Clinic of Anaesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland;Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia;Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia;Department of Anaesthesiology and Intensive Care, Péterfy Hospital and Trauma Centre, Budapest, Hungary;Department of Neurorehabilitation, ASSL Oristano, ATS Sardegna, Oristano, Italy;General Hospital Novo Mesto, Novo Mesto, Slovenia;Hungarian Army Medical Center, Budapest, Hungary;Intensive Care Unit, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy;Laboratory of Clinical Epidemiology, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Villa Camozzi, Via G.B. Camozzi 3, 24020, Ranica, Bergamo, Italy;Neurointensive Care Unit, Department of Anesthesia and Intensive Care Unit, AOU Careggi, Florence, Italy;Neurointensive Care Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy;Orobix, Bergamo, Italy;Pediatric Intensive Care Unit, Soroka Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel;University Hospital of Heraklion, Crete, Greece;University of Nicosia Medical School, Nicosia, Cyprus;University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK;

关键词: Brain injuries;    Traumatic;    Outcome assessment;    GOS-E;    Prospective studies;    Rehabilitation;   

DOI  :  10.1186/s13049-021-00959-2

来源: Springer

【 摘 要 】

BackgroundWe 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).MethodsThe 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.ResultsA 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.ConclusionsIn 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.

【 授权许可】

CC BY