Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Injury. 2021 Sep;52(9):2576-2587. doi: 10.1016/j.injury.2021.04.033. Epub 2021 Apr 20.
The aim of this manuscript is to compare characteristics, management, and outcomes of patients with severe Traumatic Brain Injury (TBI) between Australia, the United Kingdom (UK) and Europe.
We enrolled patients with severe TBI in Victoria, Australia (OzENTER-TBI), in the UK and Europe (CENTER-TBI) from 2015 to 2017. Main outcome measures were mortality and unfavourable outcome (Glasgow Outcome Scale Extended <5) 6 months after injury. Expected outcomes were compared according to the IMPACT-CT prognostic model, with observed to expected (O/E) ratios and 95% confidence intervals.
We included 107 patients from Australia, 171 from UK, and 596 from Europe. Compared to the UK and Europe, patients in Australia were younger (median 32 vs 44 vs 44 years), a larger proportion had secondary brain insults including hypotension (30% vs 17% vs 21%) and a larger proportion received ICP monitoring (75% vs 74% vs 58%). Hospital length of stay was shorter in Australia than in the UK (median: 17 vs 23 vs 16 days), and a higher proportion of patients were discharged to a rehabilitation unit in Australia than in the UK and Europe (64% vs 26% vs 28%). Mortality overall was lower than expected (27% vs 35%, O/E ratio 0.77 [95% CI: 0.64 - 0.87]. O/E ratios were comparable between regions for mortality in Australia 0.86 [95% CI: 0.49-1.23] vs UK 0.82 [0.51-1.15] vs Europe 0.76 [0.60-0.87]). Unfavourable outcome rates overall were in line with historic expectations (O/E ratio 1.32 [0.96-1.68] vs 1.13 [0.84-1.42] vs 0.96 [0.85-1.09]).
There are major differences in case-mix between Australia, UK, and Europe; Australian patients are younger and have a higher rate of secondary brain insults. Despite some differences in management and discharge policies, mortality was less than expected overall, and did not differ between regions. Functional outcomes were similar between regions, but worse than expected, emphasizing the need to improve treatment for patients with severe TBI.
本研究旨在比较澳大利亚、英国和欧洲严重创伤性脑损伤（TBI）患者的特征、治疗和结局。
我们纳入了 2015 年至 2017 年间澳大利亚维多利亚州（OzENTER-TBI）、英国和欧洲（CENTER-TBI）的严重 TBI 患者。主要结局指标为伤后 6 个月的死亡率和不良结局（格拉斯哥结局量表扩展评分<5）。根据 IMPACT-CT 预后模型比较预期结局，观察到的与预期的比值（O/E）及其 95%置信区间。
共纳入了来自澳大利亚的 107 例患者、英国的 171 例患者和欧洲的 596 例患者。与英国和欧洲相比，澳大利亚患者更年轻（中位数 32 岁比 44 岁比 44 岁），继发性脑损伤比例更高，包括低血压（30%比 17%比 21%），接受颅内压监测的比例也更高（75%比 74%比 58%）。澳大利亚患者的住院时间比英国短（中位数：17 天比 23 天比 16 天），且澳大利亚患者出院到康复病房的比例高于英国和欧洲（64%比 26%比 28%）。总体死亡率低于预期（27%比 35%，O/E 比值 0.77 [95%CI：0.64-0.87]）。澳大利亚、英国和欧洲的死亡率 O/E 比值相当，澳大利亚为 0.86 [95%CI：0.49-1.23]，英国为 0.82 [0.51-1.15]，欧洲为 0.76 [0.60-0.87]）。总体不良结局发生率与历史预期相符（O/E 比值 1.32 [0.96-1.68]比 1.13 [0.84-1.42]比 0.96 [0.85-1.09]）。
澳大利亚、英国和欧洲之间的病例特征存在显著差异；澳大利亚患者更年轻，继发性脑损伤发生率更高。尽管管理和出院政策存在差异，但总体死亡率低于预期，且不同地区之间无差异。功能结局在不同地区相似，但差于预期，这强调了需要改善严重 TBI 患者的治疗。
