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van Alphen AMIA, Krijkamp EM, Gravesteijn BY, Baatenburg de Jong RJ, Busschbach JJ. Surgical prioritization based on decision model outcomes is not sensitive to differences between the health-related quality of life values estimates of physicians and citizens. Qual Life Res 2024; 33:529-539. [PMID: 37938403 PMCID: PMC10850033 DOI: 10.1007/s11136-023-03544-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Decision models can be used to support allocation of scarce surgical resources. These models incorporate health-related quality of life (HRQoL) values that can be determined using physician panels. The predominant opinion is that one should use values obtained from citizens. We investigated whether physicians give different HRQoL values to citizens and evaluate whether such differences impact decision model outcomes. METHODS A two-round Delphi study was conducted. Citizens estimated HRQoL of pre- and post-operative health states for ten surgeries using a visual analogue scale. These values were compared using Bland-Altman analysis with HRQoL values previously obtained from physicians. Impact on decision model outcomes was evaluated by calculating the correlation between the rankings of surgeries established using the physicians' and the citizens' values. RESULTS A total of 71 citizens estimated HRQoL. Citizens' values on the VAS scale were - 0.07 points (95% CI - 0.12 to - 0.01) lower than the physicians' values. The correlation between the rankings of surgeries based on citizens' and physicians' values was 0.96 (p < 0.001). CONCLUSION Physicians put higher values on health states than citizens. However, these differences only result in switches between adjacent entries in the ranking. It would seem that HRQoL values obtained from physicians are adequate to inform decision models during crises.
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Affiliation(s)
- Anouk M I A van Alphen
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Eline M Krijkamp
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Benjamin Y Gravesteijn
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Jan J Busschbach
- Department of Medical Psychology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Gravesteijn BY, van Hof KS, Krijkamp E, Asselman F, Leemans CR, van Alphen AM, van der Horst H, Widdershoven G, de Jong LB, Lingsma H, Busschbach J, de Jong RB. Minimizing population health loss due to scarcity in OR capacity: validation of quality of life input. BMC Med Res Methodol 2023; 23:31. [PMID: 36721106 PMCID: PMC9887555 DOI: 10.1186/s12874-022-01818-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES A previously developed decision model to prioritize surgical procedures in times of scarce surgical capacity used quality of life (QoL) primarily derived from experts in one center. These estimates are key input of the model, and might be more context-dependent than the other input parameters (age, survival). The aim of this study was to validate our model by replicating these QoL estimates. METHODS The original study estimated QoL of patients in need of commonly performed procedures in live expert-panel meetings. This study replicated this procedure using a web-based Delphi approach in a different hospital. The new QoL scores were compared with the original scores using mixed effects linear regression. The ranking of surgical procedures based on combined QoL values from the validation and original study was compared to the ranking based solely on the original QoL values. RESULTS The overall mean difference in QoL estimates between the validation study and the original study was - 0.11 (95% CI: -0.12 - -0.10). The model output (DALY/month delay) based on QoL data from both studies was similar to the model output based on the original data only: The Spearman's correlation coefficient between the ranking of all procedures before and after including the new QoL estimates was 0.988. DISCUSSION Even though the new QoL estimates were systematically lower than the values from the original study, the ranking for urgency based on health loss per unit of time delay of procedures was consistent. This underscores the robustness and generalizability of the decision model for prioritization of surgical procedures.
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Affiliation(s)
- Benjamin Y. Gravesteijn
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands ,Department of Obstetrics & Gynaecology, OLVG, Amsterdam, Netherlands
| | - Kira S. van Hof
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline Krijkamp
- grid.5645.2000000040459992XDepartment of Epidemiology, Erasmus University Medical Center, currently employed by the Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Franck Asselman
- grid.509540.d0000 0004 6880 3010Strategy & Innovation department, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - C. René Leemans
- grid.12380.380000 0004 1754 9227Department of Otolaryngology – Head and Neck Surgery, Amsterdam University Medical Centres, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, Netherlands
| | - Anouk M.I.A. van Alphen
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henriëtte van der Horst
- grid.509540.d0000 0004 6880 3010Department of general practice, Amsterdam University Medical Centers Vrije Universiteit, Amsterdam, Netherlands
| | - Guy Widdershoven
- grid.12380.380000 0004 1754 9227Department of Ethics, Law and Humanities, Amsterdam University Medical Centres, Vrije Universiteit, Amsterdam, Netherlands
| | | | - Hester Lingsma
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jan Busschbach
- grid.5645.2000000040459992XDepartment of Medical Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rob Baatenburg de Jong
- grid.5645.2000000040459992XDepartment of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
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van Alphen AMIA, van Hof KS, Gravesteijn BY, Krijkamp EM, Bakx PAGM, Langenbach P, Busschbach JJ, Lingsma HF, Baatenburg de Jong RJ. Minimising population health loss in times of scarce surgical capacity: a modelling study for surgical procedures performed in nonacademic hospitals. BMC Health Serv Res 2022; 22:1456. [PMID: 36451147 PMCID: PMC9713162 DOI: 10.1186/s12913-022-08854-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The burden of the COVID-19 pandemic resulted in a reduction of available health care capacity for regular care. To guide prioritisation of semielective surgery in times of scarcity, we previously developed a decision model to quantify the expected health loss due to delay of surgery, in an academic hospital setting. The aim of this study is to validate our decision model in a nonacademic setting and include additional elective surgical procedures. METHODS In this study, we used the previously published three-state cohort state-transition model, to evaluate the health effects of surgery postponement for 28 surgical procedures commonly performed in nonacademic hospitals. Scientific literature and national registries yielded nearly all input parameters, except for the quality of life (QoL) estimates which were obtained from experts using the Delphi method. Two expert panels, one from a single nonacademic hospital and one from different nonacademic hospitals in the Netherlands, were invited to estimate QoL weights. We compared estimated model results (disability adjusted life years (DALY)/month of surgical delay) based on the QoL estimates from the two panels by calculating the mean difference and the correlation between the ranks of the different surgical procedures. The eventual model was based on the combined QoL estimates from both panels. RESULTS Pacemaker implantation was associated with the most DALY/month of surgical delay (0.054 DALY/month, 95% CI: 0.025-0.103) and hemithyreoidectomy with the least DALY/month (0.006 DALY/month, 95% CI: 0.002-0.009). The overall mean difference of QoL estimates between the two panels was 0.005 (95% CI -0.014-0.004). The correlation between ranks was 0.983 (p < 0.001). CONCLUSIONS Our study provides an overview of incurred health loss due to surgical delay for surgeries frequently performed in nonacademic hospitals. The quality of life estimates currently used in our model are robust and validate towards a different group of experts. These results enrich our earlier published results on academic surgeries and contribute to prioritising a more complete set of surgeries.
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Affiliation(s)
- Anouk M I A van Alphen
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Kira S van Hof
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Benjamin Y Gravesteijn
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Eline M Krijkamp
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Currently Employed By the Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Pieter A G M Bakx
- Department of Orthopedic Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Peter Langenbach
- CEO and Chairman of Maasstad Hospital, Rotterdam, the Netherlands.,Currently Employed By Zilveren Kruis (Achmea) Health Insurance, Leiden, the Netherlands
| | - Jan J Busschbach
- Department of Medical Psychology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hester F Lingsma
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Volovici V, Pisică D, Gravesteijn BY, Dirven CMF, Steyerberg EW, Ercole A, Stocchetti N, Nelson D, Menon DK, Citerio G, van der Jagt M, Maas AIR, Haitsma IK, Lingsma HF, Åkerlund C, Amrein K, Andelic N, Andreassen L, Audibert G, Azouvi P, Azzolini ML, Bartels R, Beer R, Bellander BM, Benali H, Berardino M, Beretta L, Beqiri E, Blaabjerg M, Lund SB, Brorsson C, Buki A, Cabeleira M, Caccioppola A, Calappi E, Calvi MR, Cameron P, Lozano GC, Castaño-León AM, Cavallo S, Chevallard G, Chieregato A, Coburn M, Coles J, Cooper JD, Correia M, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Dark P, De Keyser V, Degos V, Corte FD, Boogert HD, Depreitere B, Dilvesi D, Dixit A, Dreier J, Dulière GL, Ezer E, Fabricius M, Foks K, Frisvold S, Furmanov A, Galanaud D, Gantner D, Ghuysen A, Giga L, Golubovic J, Gomez PA, Grossi F, Gupta D, Haitsma I, Helseth E, Hutchinson PJ, Jankowski S, Johnson F, Karan M, Kolias AG, Kondziella D, Koraropoulos E, Koskinen LO, Kovács N, Kowark A, Lagares A, Laureys S, Ledoux D, Lejeune A, Lightfoot R, Manara A, Martino C, Maréchal H, Mattern J, McMahon C, Menovsky T, Misset B, Muraleedharan V, Murray L, Negru A, Newcombe V, Nyirádi J, Ortolano F, Payen JF, Perlbarg V, Persona P, Piippo-Karjalainen A, Ples H, Pomposo I, Posti JP, Puybasset L, Radoi A, Ragauskas A, Raj R, Rhodes J, Richter S, Rocka S, Roe C, Roise O, Rosenfeld JV, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Sahuquillo J, Sandrød O, Sakowitz O, Sanchez-Porras R, Schirmer-Mikalsen K, Schou RF, Smielewski P, Sorinola A, Stamatakis E, Sundström N, Takala R, Tamás V, Tamosuitis T, Tenovuo O, Thomas M, Tibboel D, Tolias C, Trapani T, Tudora CM, Vajkoczy P, Vallance S, Valeinis E, Vámos Z, Van der Steen G, van Wijk RPJ, Vargiolu A, Vega E, Vik A, Vilcinis R, Vulekovic P, Williams G, Winzeck S, Wolf S, Younsi A, Zeiler FA, Ziverte A, Clusmann H, Voormolen D, van Dijck JTJM, van Essen TA. Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochir (Wien) 2022; 164:1693-1705. [PMID: 35648213 PMCID: PMC9233652 DOI: 10.1007/s00701-022-05257-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 05/11/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE To compare outcomes between patients with primary external ventricular device (EVD)-driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)-driven treatment. METHODS The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with "center" as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. RESULTS A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36-1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34-2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. CONCLUSION We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor-guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group. PROTOCOL The core study is registered with ClinicalTrials.gov , number NCT02210221, and the Resource Identification Portal (RRID: SCR_015582).
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Gravesteijn BY, Thornton JG, Katsanevakis E, Mol BW. Concerns about the reliability of a trial of oral progesterone for preterm birth included in a meta-analysis. Am J Obstet Gynecol MFM 2022; 4:100664. [PMID: 35654321 DOI: 10.1016/j.ajogmf.2022.100664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jim G Thornton
- Department of Obstetrics and Gynaecology, University of Nottingham, Nottingham, United Kingdom
| | - Emmanouil Katsanevakis
- Department of Obstetrics and Gynaecology, United Lincolnshire Hospitals Trust, Lincoln, United Kingdom
| | - Ben Willem Mol
- Department of Obstetrcis and Gynaecology, Monash University, Clayton, Australia
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Klimek M, Gravesteijn BY, Costa AM, Lobo FA. How to Study the Brain While Anesthetizing It?! A Scoping Review on Running Neuroanesthesiologic Studies and Trials That Include Neurosurgical Patients. World Neurosurg 2022; 161:376-381. [PMID: 35505557 DOI: 10.1016/j.wneu.2021.08.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/13/2021] [Indexed: 11/26/2022]
Abstract
This scoping review addresses the challenges of neuroanesthesiologic research: the population, the methods/treatment/exposure, and the outcome/results. These challenges are put into the context of a future research agenda for peri-/intraoperative anesthetic management, neurocritical care, and applied neurosciences. Finally, the opportunities of adaptive trial design in neuroanesthesiologic research are discussed.
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Affiliation(s)
- Markus Klimek
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Benjamin Y Gravesteijn
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andreia M Costa
- Department of Anesthesiology, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Francisco A Lobo
- Institute of Anesthesiology, Cleveland Clinic, Abu Dhabi, United Arabic Emirates
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Oosterhoff JHF, Gravesteijn BY, Karhade AV, Jaarsma RL, Kerkhoffs GMMJ, Ring D, Schwab JH, Steyerberg EW, Doornberg JN. Feasibility of Machine Learning and Logistic Regression Algorithms to Predict Outcome in Orthopaedic Trauma Surgery. J Bone Joint Surg Am 2022; 104:544-551. [PMID: 34921550 DOI: 10.2106/jbjs.21.00341] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Statistical models using machine learning (ML) have the potential for more accurate estimates of the probability of binary events than logistic regression. The present study used existing data sets from large musculoskeletal trauma trials to address the following study questions: (1) Do ML models produce better probability estimates than logistic regression models? (2) Are ML models influenced by different variables than logistic regression models? METHODS We created ML and logistic regression models that estimated the probability of a specific fracture (posterior malleolar involvement in distal spiral tibial shaft and ankle fractures, scaphoid fracture, and distal radial fracture) or adverse event (subsequent surgery [after distal biceps repair or tibial shaft fracture], surgical site infection, and postoperative delirium) using 9 data sets from published musculoskeletal trauma studies. Each data set was split into training (80%) and test (20%) subsets. Fivefold cross-validation of the training set was used to develop the ML models. The best-performing model was then assessed in the independent testing data. Performance was assessed by (1) discrimination (c-statistic), (2) calibration (slope and intercept), and (3) overall performance (Brier score). RESULTS The mean c-statistic was 0.01 higher for the logistic regression models compared with the best ML models for each data set (range, -0.01 to 0.06). There were fewer variables strongly associated with variation in the ML models, and many were dissimilar from those in the logistic regression models. CONCLUSIONS The observation that ML models produce probability estimates comparable with logistic regression models for binary events in musculoskeletal trauma suggests that their benefit may be limited in this context.
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Affiliation(s)
- Jacobien H F Oosterhoff
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Benjamin Y Gravesteijn
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Aditya V Karhade
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruurd L Jaarsma
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas, Austin, Texas
| | - Joseph H Schwab
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Job N Doornberg
- Department of Orthopaedic & Trauma Surgery, Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia
- Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Schluep M, Endeman H, Gravesteijn BY, Kuijs C, Blans MJ, van den Bogaard B, Van Gemert AWMMK, Hukshorn CJ, van der Meer BJM, Knook AHM, van Melsen T, Peters R, Simons KS, Spijkers G, Vermeijden JW, Wils EJ, Stolker RJ, Hoeks SE. In-depth assessment of health-related quality of life after in-hospital cardiac arrest. J Crit Care 2021; 68:22-30. [PMID: 34856490 DOI: 10.1016/j.jcrc.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Evidence on physical and psychological well-being of in-hospital cardiac arrest (IHCA) survivors is scarce. The aim of this study is to describe long-term health-related quality of life (HRQoL), functional independence and psychological distress 3 and 12 months post-IHCA. METHODS A multicenter prospective cohort study in 25 hospitals between January 2017 - May 2018. Adult IHCA survivors were included. HRQoL (EQ-5D-5L, SF-12), psychological distress (HADS, CSI) and functional independence (mRS) were assessed at 3 and 12 months post-IHCA. RESULTS At 3-month follow-up 136 of 212 survivors responded to the questionnaire and at 12 months 110 of 198 responded. The median (IQR) EQ-utility Index score was 0.77 (0.65-0.87) at 3 months and 0.81 (0.70-0.91) at 12 months. At 3 months, patients reported a median SF-12 (IQR) physical component scale (PCS) of 38.9 (32.8-46.5) and mental component scale (MCS) of 43.5 (34.0-39.7) and at 12 months a PCS of 43.1 (34.6-52.3) and MCS 46.9 (38.5-54.5). DISCUSSION Using various tools most IHCA survivors report an acceptable HRQoL and a substantial part experiences lower HRQoL compared to population norms. Our data suggest that younger (male) patients and those with poor functional status prior to admission are at highest risk of impaired HRQoL.
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Affiliation(s)
- M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - H Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - B Y Gravesteijn
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - C Kuijs
- Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands; Resuscitation Committee, Maasstad Hospital, Rotterdam, the Netherlands
| | - M J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - B van den Bogaard
- Department of Intensive Care Medicine, OLVG, Amsterdam, the Netherlands
| | | | - C J Hukshorn
- Department of Intensive Care Medicine, Isala Hospital, Zwolle, the Netherlands
| | | | - A H M Knook
- Department of Intensive Care Medicine, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - T van Melsen
- Department of Intensive Care Medicine, Haaglanden Medisch Centrum, The Hague, the Netherlands
| | - R Peters
- Department of Cardiology, Tergooi Hospital, Hilversum, the Netherlands
| | - K S Simons
- Department of Intensive Care Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - G Spijkers
- Department of Hospital Medicine, ZorgSaam Zeeuws-Vlaanderen, Terneuzen, the Netherlands
| | - J W Vermeijden
- Department of Intensive Care Medicine, Medisch Spectrum Twente, Enschede, the Netherlands
| | - E-J Wils
- Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Gravesteijn BY, Schluep M, Lingsma HF, Stolker RJ, Endeman H, Hoeks SE. Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study. Crit Care 2021; 25:329. [PMID: 34507601 PMCID: PMC8431928 DOI: 10.1186/s13054-021-03754-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.
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Affiliation(s)
- B Y Gravesteijn
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands.
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - M Schluep
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands
| | - R J Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - H Endeman
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S E Hoeks
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Sewalt CA, Gravesteijn BY, Nieboer D, Steyerberg EW, Den Hartog D, Van Klaveren D. Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers. BMC Emerg Med 2021; 21:93. [PMID: 34362302 PMCID: PMC8344140 DOI: 10.1186/s12873-021-00487-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 07/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Prehospital triage protocols typically try to select patients with Injury Severity Score (ISS) above 15 for direct transportation to a Level-1 trauma center. However, ISS does not necessarily discriminate between patients who benefit from immediate care at Level-1 trauma centers. The aim of this study was to assess which patients benefit from direct transportation to Level-1 trauma centers. Methods We used the American National Trauma Data Bank (NTDB), a retrospective observational cohort. All adult patients (ISS > 3) between 2015 and 2016 were included. Patients who were self-presenting or had isolated limb injury were excluded. We used logistic regression to assess the association of direct transportation to Level-1 trauma centers with in-hospital mortality adjusted for clinically relevant confounders. We used this model to define benefit as predicted probability of mortality associated with transportation to a non-Level-1 trauma center minus predicted probability associated with transportation to a Level-1 trauma center. We used a threshold of 1% as absolute benefit. Potential interaction terms with transportation to Level-1 trauma centers were included in a penalized logistic regression model to study which patients benefit. Results We included 388,845 trauma patients from 232 Level-1 centers and 429 Level-2/3 centers. A small beneficial effect was found for direct transportation to Level-1 trauma centers (adjusted Odds Ratio: 0.96, 95% Confidence Interval: 0.92–0.99) which disappeared when comparing Level-1 and 2 versus Level-3 trauma centers. In the risk approach, predicted benefit ranged between 0 and 1%. When allowing for interactions, 7% of the patients (n = 27,753) had more than 1% absolute benefit from direct transportation to Level-1 trauma centers. These patients had higher AIS Head and Thorax scores, lower GCS and lower SBP. A quarter of the patients with ISS > 15 were predicted to benefit from transportation to Level-1 centers (n = 26,522, 22%). Conclusions Benefit of transportation to a Level-1 trauma centers is quite heterogeneous across patients and the difference between Level-1 and Level-2 trauma centers is small. In particular, patients with head injury and signs of shock may benefit from care in a Level-1 trauma center. Future prehospital triage models should incorporate more complete risk profiles. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00487-3.
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Affiliation(s)
- Charlie A Sewalt
- Department of Public Health, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands. .,Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.
| | - Benjamin Y Gravesteijn
- Department of Public Health, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands
| | - Daan Nieboer
- Department of Public Health, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands
| | - David Van Klaveren
- Department of Public Health, Erasmus MC University Medical Center, Na-building, room Na-2318, Wytemaweg 80, 3015, Rotterdam, CN, The Netherlands
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Czeiter E, Amrein K, Gravesteijn BY, Lecky F, Menon DK, Mondello S, Newcombe VFJ, Richter S, Steyerberg EW, Vyvere TV, Verheyden J, Xu H, Yang Z, Maas AIR, Wang KKW, Büki A. Blood biomarkers on admission in acute traumatic brain injury: Relations to severity, CT findings and care path in the CENTER-TBI study. EBioMedicine 2020; 56:102785. [PMID: 32464528 PMCID: PMC7251365 DOI: 10.1016/j.ebiom.2020.102785] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/28/2020] [Accepted: 04/22/2020] [Indexed: 01/20/2023] Open
Abstract
Background Serum biomarkers may inform and improve care in traumatic brain injury (TBI). We aimed to correlate serum biomarkers with clinical severity, care path and imaging abnormalities in TBI, and explore their incremental value over clinical characteristics in predicting computed tomographic (CT) abnormalities. Methods We analyzed six serum biomarkers (S100B, NSE, GFAP, UCH-L1, NFL and t-tau) obtained <24 h post-injury from 2867 patients with any severity of TBI in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) Core Study, a prospective, multicenter, cohort study. Univariable and multivariable logistic regression analyses were performed. Discrimination was assessed by the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals. Findings All biomarkers scaled with clinical severity and care path (ER only, ward admission, or ICU), and with presence of CT abnormalities. GFAP achieved the highest discrimination for predicting CT abnormalities (AUC 0•89 [95%CI: 0•87–0•90]), with a 99% likelihood of better discriminating CT-positive patients than clinical characteristics used in contemporary decision rules. In patients with mild TBI, GFAP also showed incremental diagnostic value: discrimination increased from 0•84 [95%CI: 0•83–0•86] to 0•89 [95%CI: 0•87–0•90] when GFAP was included. Results were consistent across strata, and injury severity. Combinations of biomarkers did not improve discrimination compared to GFAP alone. Interpretation Currently available biomarkers reflect injury severity, and serum GFAP, measured within 24 h after injury, outperforms clinical characteristics in predicting CT abnormalities. Our results support the further development of serum GFAP assays towards implementation in clinical practice, for which robust clinical assay platforms are required. Funding CENTER-TBI study was supported by the European Union 7th Framework program (EC grant 602150).
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Affiliation(s)
- Endre Czeiter
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary; MTA-PTE Clinical Neuroscience MR Research Group, Rét u. 2, H-7623 Pécs, Hungary.
| | - Krisztina Amrein
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | - Benjamin Y Gravesteijn
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Fiona Lecky
- Centre for Urgent and emergency care REsearch (CURE), Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, S1 4DA, UK; Emergency Department, Salford Royal Hospital, Stott Ln, Salford M6 8HD, UK
| | - David K Menon
- Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria n. 1, 98125 Messina, Italy
| | - Virginia F J Newcombe
- Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Sophie Richter
- Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
| | - Ewout W Steyerberg
- Center for Medical Decision Making, Department of Public Health, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Thijs Vande Vyvere
- Research and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium; Department of Radiology, Antwerp University Hospital and University of Antwerp, Wijlrijkstraat 10, 2650 Edegem, Belgium
| | - Jan Verheyden
- Research and Development, Icometrix, Kolonel Begaultlaan 1b/12, 3012 Leuven, Belgium
| | - Haiyan Xu
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA
| | - Zhihui Yang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Wijlrijkstraat 10, 2650 Edegem, Belgium
| | - Kevin K W Wang
- Program for Neurotrauma, Neuroproteomics and Biomarker Research, Departments of Emergency Medicine, Psychiatry and Neuroscience, University of Florida, McKnight Brain Institute, L4-100L 1149 South Newell Drive, Gainesville, FL 32611, USA; Brain Rehabilitation Research Center, Malcom Randall Veterans Affairs Medical Center (VAMC), 1601 SW Archer Rd. Gainesville, FL 32608, USA
| | - András Büki
- Department of Neurosurgery, Medical School, University of Pécs, Rét u. 2, H-7623 Pécs, Hungary; Neurotrauma Research Group, Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
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12
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Gravesteijn BY, Nieboer D, Ercole A, Lingsma HF, Nelson D, van Calster B, Steyerberg EW. Machine learning algorithms performed no better than regression models for prognostication in traumatic brain injury. J Clin Epidemiol 2020; 122:95-107. [PMID: 32201256 DOI: 10.1016/j.jclinepi.2020.03.005] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/04/2020] [Accepted: 03/09/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVE We aimed to explore the added value of common machine learning (ML) algorithms for prediction of outcome for moderate and severe traumatic brain injury. STUDY DESIGN AND SETTING We performed logistic regression (LR), lasso regression, and ridge regression with key baseline predictors in the IMPACT-II database (15 studies, n = 11,022). ML algorithms included support vector machines, random forests, gradient boosting machines, and artificial neural networks and were trained using the same predictors. To assess generalizability of predictions, we performed internal, internal-external, and external validation on the recent CENTER-TBI study (patients with Glasgow Coma Scale <13, n = 1,554). Both calibration (calibration slope/intercept) and discrimination (area under the curve) was quantified. RESULTS In the IMPACT-II database, 3,332/11,022 (30%) died and 5,233(48%) had unfavorable outcome (Glasgow Outcome Scale less than 4). In the CENTER-TBI study, 348/1,554(29%) died and 651(54%) had unfavorable outcome. Discrimination and calibration varied widely between the studies and less so between the studied algorithms. The mean area under the curve was 0.82 for mortality and 0.77 for unfavorable outcomes in the CENTER-TBI study. CONCLUSION ML algorithms may not outperform traditional regression approaches in a low-dimensional setting for outcome prediction after moderate or severe traumatic brain injury. Similar to regression-based prediction models, ML algorithms should be rigorously validated to ensure applicability to new populations.
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Affiliation(s)
- Benjamin Y Gravesteijn
- Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Daan Nieboer
- Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Hester F Lingsma
- Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - David Nelson
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Ben van Calster
- Department of Development and Regeneration, KU Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ewout W Steyerberg
- Departments of Public Health, Erasmus MC - University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
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13
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Gravesteijn BY, Sewalt CA, Ercole A, Akerlund C, Nelson D, Maas AIR, Menon D, Lingsma HF, Steyerberg EW. Toward a New Multi-Dimensional Classification of Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research for Traumatic Brain Injury Study. J Neurotrauma 2019; 37:1002-1010. [PMID: 31672086 DOI: 10.1089/neu.2019.6764] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Traumatic brain injury (TBI) is currently classified as mild, moderate, or severe TBI by trichotomizing the Glasgow Coma Scale (GCS). We aimed to explore directions for a more refined multidimensional classification system. For that purpose, we performed a hypothesis-free cluster analysis in the Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI) database: a European all-severity TBI cohort (n = 4509). The first building block consisted of key imaging characteristics, summarized using principal component analysis from 12 imaging characteristics. The other building blocks were demographics, clinical severity, secondary insults, and cause of injury. With these building blocks, the patients were clustered into four groups. We applied bootstrap resampling with replacement to study the stability of cluster allocation. The characteristics that predominantly defined the clusters were injury cause, major extracranial injury, and GCS. The clusters consisted of 1451, 1534, 1006, and 518 patients, respectively. The clustering method was quite stable: the proportion of patients staying in one cluster after resampling and reclustering was 97.4% (95% confidence interval [CI]: 85.6-99.9%). These clusters characterized groups of patients with different functional outcomes: from mild to severe, 12%, 19%, 36%, and 58% of patients had unfavorable 6 month outcome. Compared with the mild and the upper intermediate cluster, the lower intermediate and the severe cluster received more key interventions. To conclude, four types of TBI patients may be defined by injury mechanism, presence of major extracranial injury and GCS. Describing patients according to these three characteristics could potentially capture differences in etiology and care pathways better than with GCS only.
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Affiliation(s)
| | - Charlie A Sewalt
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Cecilia Akerlund
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - David Nelson
- Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Hester F Lingsma
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Centre Leiden, The Netherlands
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14
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Voormolen DC, Haagsma JA, Polinder S, Maas AI, Steyerberg EW, Vuleković P, Sewalt CA, Gravesteijn BY, Covic A, Andelic N, Plass AM, von Steinbuechel N. Post-Concussion Symptoms in Complicated vs. Uncomplicated Mild Traumatic Brain Injury Patients at Three and Six Months Post-Injury: Results from the CENTER-TBI Study. J Clin Med 2019; 8:jcm8111921. [PMID: 31717436 PMCID: PMC6912209 DOI: 10.3390/jcm8111921] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to assess the occurrence of post-concussion symptoms and post-concussion syndrome (PCS) in a large cohort of patients after complicated and uncomplicated mild traumatic brain injury (mTBI) at three and six months post-injury. Patients were included through the prospective cohort study: Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI). Patients enrolled with mTBI (Glasgow Coma Scale 13-15) were further differentiated into complicated and uncomplicated mTBI based on the presence or absence of computed tomography abnormalities, respectively. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) assessed post-concussion symptoms and PCS according to the mapped ICD-10 classification method. The occurrence of post-concussion symptoms and syndrome at both time points was calculated. Chi square tests were used to test for differences between and within groups. Logistic regression was performed to analyse the association between complicated versus uncomplicated mTBI and the prevalence of PCS. Patients after complicated mTBI reported slightly more post-concussion symptoms compared to those after uncomplicated mTBI. A higher percentage of patients after complicated mTBI were classified as having PCS at three (complicated: 46% vs. uncomplicated: 35%) and six months (complicated: 43% vs. uncomplicated 34%). After adjusting for baseline covariates, the effect of complicated versus uncomplicated mTBI at three months appeared minimal: odds ratio 1.25 (95% confidence interval: 0.95-1.66). Although patients after complicated mTBI report slightly more post-concussion symptoms and show higher PCS rates compared to those after uncomplicated mTBI at three and six months, complicated mTBI was only found a weak indicator for these problems.
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Affiliation(s)
- Daphne C. Voormolen
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Correspondence: ; Tel.: +316-28-683-742
| | - Juanita A. Haagsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Andrew I.R. Maas
- Department of Neurosurgery, Antwerp University Hospital, 2650 Edegem, Belgium;
- Department of Neurosurgery, University of Antwerp, 2000 Edegem, Belgium
| | - Ewout W. Steyerberg
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Petar Vuleković
- Clinic of Neurosurgery, Clinical Centre of Vojvodina, 21000 Novi Sad, Serbia;
| | - Charlie A. Sewalt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Benjamin Y. Gravesteijn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands; (J.A.H.); (S.P.); (E.W.S.); (C.A.S.); (B.Y.G.)
| | - Amra Covic
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0372 Oslo, Norway;
- Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, 0318 Oslo, Norway
| | - Anne Marie Plass
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Göttingen (UMG), 37075 Göttingen, Germany; (A.C.); (A.M.P.); (N.v.S.)
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15
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Gravesteijn BY, Sewalt CA, Ercole A, Lecky F, Menon D, Steyerberg EW, Maas AIR, Lingsma HF, Klimek M. Variation in the practice of tracheal intubation in Europe after traumatic brain injury: a prospective cohort study. Anaesthesia 2019; 75:45-53. [PMID: 31520421 PMCID: PMC7344983 DOI: 10.1111/anae.14838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2019] [Indexed: 01/03/2023]
Abstract
Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubation practice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injury included in the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER‐TBI) in 45 centres in 16 European countries. We included patients who were transported to hospital by emergency medical services. We used mixed‐effects multinomial regression to quantify the effects on pre‐hospital or in‐hospital tracheal intubation of the following: patient characteristics; injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Of these, 1322 (34%) had their tracheas intubated; 839 (22%) pre‐hospital and 483 (13%) in‐hospital. The fit of the model with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability of tracheal intubation increased with the following: younger age; lower pre‐hospital or emergency department GCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviated injury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between two randomly chosen centres was 3.1 (95%CI 2.1–4.3) for pre‐hospital intubation, and 2.7 (95%CI 1.9–3.5) for in‐hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre‐hospital intubation (OR 2.9, 95%CI 1.3–6.6), in contrast to the presence of ambulance personnel who are allowed to intubate (OR 0.5, 95%CI 0.3–0.8). In conclusion, patient and injury characteristics are key drivers of tracheal intubation. Between‐centre differences were also substantial. Further studies are needed to improve the evidence base supporting recommendations for tracheal intubation.
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Affiliation(s)
- B Y Gravesteijn
- Departments of Anesthesiology and Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C A Sewalt
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - A Ercole
- Department of Anaesthesiology, University of Cambridge, UK
| | - F Lecky
- Emergency Medicine Research in Sheffield, School of Health and Related Research, Faculty of Medicine, Dentistry and Health, University of Sheffield, UK
| | - D Menon
- Department of Anaesthesia, University of Cambridge, UK
| | - E W Steyerberg
- Department of Biostatistics, Leiden University Medical Centre, Leiden, The Netherlands
| | - A I R Maas
- Department of Neurosurgery, University Hospital Antwerp, Belgium
| | - H F Lingsma
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M Klimek
- Department of Anesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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16
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Voormolen DC, Cnossen MC, Polinder S, Gravesteijn BY, Von Steinbuechel N, Real RGL, Haagsma JA. Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom. Brain Inj 2019; 33:1078-1086. [PMID: 31032649 DOI: 10.1080/02699052.2019.1607557] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: To evaluate the frequency of post-concussion symptoms and prevalence and risk factors of post-concussion syndrome (PCS) in the general population, investigate the association between the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and self-perceived health, and evaluate differences between three European countries. Methods: A web-based survey including the RPQ and EQ-5D was conducted among representative samples in three European countries. Results: A total of 11,759 respondents completed the questionnaire. The most frequently reported symptom was fatigue (49.9%). Almost half (45.1%) of the respondents were classified as having PCS considering rating score 2 (three RPQ items with score ≥ 2) as a cut-off. Chronic health complaints were found as a significant risk factor for PCS. All items of the RPQ were positively correlated with the EQ-5D and the strongest positive correlation (0.633, p<0.001) was between RPQ item 'feeling depressed or tearful' and EQ-5D domain 'anxiety/depression'. Conclusions: We found a high frequency of post-concussion-like symptoms and PCS in the general population, indicating that these symptoms are not specific for patients with traumatic brain injury (TBI), and PCS is not a unique syndrome after TBI. Therefore, the use of post-concussion symptoms and PCS as outcome following mild TBI should be interpreted with caution.
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Affiliation(s)
- Daphne C Voormolen
- a Department of Public Health , Erasmus University Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Maryse C Cnossen
- a Department of Public Health , Erasmus University Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Suzanne Polinder
- a Department of Public Health , Erasmus University Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Benjamin Y Gravesteijn
- a Department of Public Health , Erasmus University Medical Centre Rotterdam , Rotterdam , the Netherlands
| | - Nicole Von Steinbuechel
- b Institute of Medical Psychology and Medical Sociology , Georg-August-University , Göttingen , Germany
| | - Ruben G L Real
- b Institute of Medical Psychology and Medical Sociology , Georg-August-University , Göttingen , Germany
| | - Juanita A Haagsma
- a Department of Public Health , Erasmus University Medical Centre Rotterdam , Rotterdam , the Netherlands.,c Department of Emergency Medicine , Erasmus University Medical Centre , Rotterdam , the Netherlands
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