Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study

Abstract

IntroductionThe strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study.MethodsWe designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions.ResultsAll 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers.ConclusionEven among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.

Emergency department overcrowding: a survey among European neurotrauma centres

“…This study was part of the provider profiling study of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) 4. Ethical approval was obtained for CENTER-TBI 3…”

“…Questionnaires were developed through a comprehensive literature search and expert opinion meetings, and were pilot-tested in 16 of the participating centres. Reliability of the set of questionnaires was assessed by calculating the concordance rate among 5% duplicate questions and was adequate (median: 0.85) 4. The relevant questions are reproduced in table 1.…”

Brain death and postmortem organ donation: report of a questionnaire from the CENTER-TBI study

“…More detailed information about the development, administration, and content of the questionnaires is available from an earlier publication by Cnossen et al [9]. …”

Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study

“…Outcomes were assessed at the ICU and at 3, 6, 12, and 24 months. In addition, questionnaires were completed by participating centres on structures and processes of care (Provider Profiling questionnaires [13]).…”

“…For outcome, the centres had a median [IQR] ICU mortality of 12% [9][10][11][12][13][14][15][16][17][18][19][20][21], ventilator-acquired pneumonia Level I trauma centre: A regional resource centre that generally serves large cities or population-dense areas. A level I trauma centre is expected to manage large numbers of severely injured patients (at least 1200 trauma patients annually or have 240 admissions with an injury severity score of more than 14).…”