Care transitions in the first 6 months following traumatic brain injury: Lessons from the CENTER-TBI study
Borgen, Ida Maria Henriksen; Røe, Cecilie; Brunborg, Cathrine; Tenovuo, Olli; Azouvi, Philippe; Dawes, Helen; Majdan, Marek; Ranta, Jukka; Rusnak, Martin; Wiegers, E; Tverdal, Cathrine Buaas; Jacob, Louis; Cogne, Melanie; von Steinbuechel, Nicole; Andelic, Nada; Andreassen, Lasse; Anke, Audny; Frisvold, Shirin; Helseth, Eirik; Røise, Olav; Skandsen, Toril; Vik, Anne; Åkerlund, Cecilia; Amrein, Krisztina; Antoni, Anna; Audibert, Gerard; Azzolini, Maria Luisa; Bartels, Ronald; Barzo, Pal; Beauvais, Romuald; Beer, Ronny; Bellander, Bo-Michael; Belli, Antonio; Benali, Habib; Berardino, Maurizio; Beretta, Luigi; Blaabjerg, Morten; Bragge, Peter; Brazinova, Alexandra; Brinck, Vibeke; Brooker, Joanne; Brorsson, Camilla; Buki, Andras; Bullinger, Monika; Cabeleira, Manuel; Caccioppola, Alessio; Calappi, Emiliana; Calvi, Maria Rosa; Cameron, Peter; Lozano, Guillermo Carbayo
Peer reviewed, Journal article
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Original versionAnnals of Physical and Rehabilitation Medicine. 2021, 64 (6), . 10.1016/j.rehab.2020.10.009
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.