Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Ann Phys Rehabil Med. 2021 Nov;64(6):101458. doi: 10.1016/j.rehab.2020.10.009. Epub 2021 Jul 23.
No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI).
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.
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).
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.
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.
ClinicalTrials.gov NCT02210221.
目前尚无国际性研究调查过创伤性脑损伤（TBI）患者在急性住院期间或之后的照护交接情况。
描述 TBI 患者在创伤后 6 个月内的各种 TBI 照护路径和相关交接次数，并评估这些因素对功能 TBI 结局的影响，同时控制人口统计学和损伤相关因素。
这是一项队列研究，纳入了参与协作性欧洲颅脑外伤疗效研究（CENTER-TBI）的多个创伤中心的 TBI 患者。确定交接次数和特定的照护路径。使用多变量逻辑回归分析来评估 6 个月时的交接次数和照护路径对损伤后格拉斯哥结局量表扩展版（GOSE）评估的功能结局的影响。
共有 3133 例 TBI 患者存活下来并完成了急性 TBI 照护路径，其中至少有 1 例在 6 个月的随访中有记录的院内交接。交接次数的中位数为 3（四分位距 2-3）。交接次数并不能预测 6 个月时的功能结局（比值比 1.08，95%置信区间 1.09-1.18；P=0.063）。共确定了 378 种不同的照护路径；有 8 种路径至少有 100 例患者相同，被定义为“常见路径”。其中 5 种常见的照护路径可预测 6 个月时更好的功能结局，而其余 3 种路径与结局无关。在这两种模型中，年龄较大、暴力是受伤的原因、受伤前存在系统性疾病、颅内和总体损伤严重程度以及南欧/东欧地区与 6 个月时不良的功能结局相关。
TBI 患者存在大量不同且复杂的照护路径，尤其是那些严重受伤的患者。如此高数量和多样性的照护路径表明，需要为未来的研究制定 TBI 照护路径的“通用数据元素”并进行标准化。
ClinicalTrials.gov NCT02210221。
