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

Ida M H Borgen; Cecilie Røe; Cathrine Brunborg; Olli Tenovuo; Philippe Azouvi; Helen Dawes; Marek Majdan; Jukka Ranta; Martin Rusnak; Eveline J A Wiegers; Cathrine Tverdal; Louis Jacob; Mélanie Cogné; Nicole von Steinbuechel; Nada Andelic; CENTER-TBI participants investigators

doi:10.1016/j.rehab.2020.10.009

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

Ann Phys Rehabil Med. 2021 Nov;64(6):101458. doi: 10.1016/j.rehab.2020.10.009. Epub 2021 Jul 23.

Authors

Affiliations

¹ 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: [email protected].
² Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
⁴ Turku Brain Injury Centre, University of Turku and Turku University Hospital, Turku, Finland.
⁵ AP-HP, GH Paris-Saclay, Hopital Raymond Poincaré, Garches and Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.
⁶ Oxford Brookes University, health and life sciences, Oxford, UK.
⁷ Trnava University, Faculty of Health Sciences and Social Work, Department of Public Health, Institute for Global Health and Epidemiology, Slovakia.
⁸ VTT Technical Research Centre of Finland Ltd, Finland.
⁹ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
¹⁰ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
¹¹ Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France.
¹² University Hospital of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
¹³ Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Germany.
¹⁴ 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.

PMID: 33246186
DOI: 10.1016/j.rehab.2020.10.009

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.

MeSH terms

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

Associated data

ClinicalTrials.gov/NCT02210221