• Jilske A Huijben, Eveline J A Wiegers, Hester F Lingsma, Giuseppe Citerio, Maas Andrew I R AIR Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium., David K Menon, Ari Ercole, David Nelson, Mathieu van der Jagt, Ewout W Steyerberg, Raimund Helbok, Fiona Lecky, Wilco Peul, Tatiana Birg, Tommaso Zoerle, Marco Carbonara, Nino Stocchetti, and CENTER-TBI investigators and participants.
• Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. j.a.huijben@erasmusmc.nl.
• Intensive Care Med. 2020 May 1; 46 (5): 995-1004.

PurposeTo describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers.MethodsThis is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers.ResultsA total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13-15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01).ConclusionsHalf of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources.

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