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Observational Study
. 2021 Nov 2;29(1):158.
doi: 10.1186/s13049-021-00959-2.

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

Aimone Giugni #  1 , Lorenzo Gamberini #  1 , Greta Carrara  2 , Luca Antiga  3 , Obou Brissy  2 , Virginia Buldini  1 , Italo Calamai  4 , Akos Csomos  5 , Alessandra De Luca  6 , Enrico Ferri  1 , Joanne M Fleming  2 , Primoz Gradisek  7   8 , Rafael Kaps  9 , Theodoros Kyprianou  10   11 , Silvia Lagomarsino  6 , Isaac Lazar  12 , Costanza Martino  13 , Malgorzata Mikaszewska-Sokolewicz  14 , Andrea Montis  15 , Gabor Nardai  16 , Giovanni Nattino  17 , Giuseppe Nattino  18 , Giulia Paci  2 , Laila Portolani  13 , Nektaria Xirouchaki  19 , Arturo Chieregato  20 , Guido Bertolini  2 ; CREACTIVE consortium
Collaborators, Affiliations
Observational Study

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

Aimone Giugni et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH).

Methods: The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality.

Results: A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk.

Conclusions: In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

Keywords: Brain injuries; GOS-E; Outcome assessment; Prospective studies; Rehabilitation; Traumatic.

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Conflict of interest statement

ArC reports a patent null pending, outside the submitted work. The other authors declare that they have no other conflict of interest.

Figures

Fig. 1
Fig. 1
Flow-chart describing the patient selection
Fig. 2
Fig. 2
Distributions of the probability of hospital mortality as calculated by the SAPSII score (top panel), GCS before any treatment (central panel) and Marshall classification (bottom panel) in the NSH and no-NSH groups of the matched sample
Fig. 3
Fig. 3
For each SAPSII, GCS and Marshall stratum, the bars compare the distribution of the 6-month GOS-E levels between the NSH and no-NSH groups
See this image and copyright information in PMC

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