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  1. Article ; Online: A Model Predicting the 6-Month Disability of Patients With Traumatic Brain Injury to Assess the Quality of Care in Intensive Care Units: Results from the CREACTIVE Study.

    Nattino, Giovanni / Lemeshow, Stanley / Carrara, Greta / Rossi, Carlotta / Brissy, Obou / Chieregato, Arturo / Csomos, Akos / Fleming, Joanne M / Giugni, Aimone / Gradisek, Primoz / Kaps, Rafael / Kyprianou, Theodoros / Lazar, Isaac / Mikaszewska-Sokolewicz, Malgorzata / Paci, Giulia / Xirouchaki, Nektaria / Bertolini, Guido

    Journal of neurotrauma

    2024  

    Abstract: Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and ... ...

    Abstract Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and applying it to the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) consortium, which involved 83 ICUs from seven countries. The performance of the centers was assessed in terms of patients' outcomes, as measured by the 6-month Glasgow Outcome Scale-Extended (GOS-E). To account for the between-center differences in the characteristics of the admitted patients, we developed a multinomial logistic regression model estimating the probability of a four-level categorization of the GOS-E: good recovery (GR), moderate disability (MD), severe disability (SD), and death or vegetative state (D/VS). A total of 5928 patients admitted to the participating ICUs between March 2014 and March 2019 were analyzed. The model included 11 predictors and demonstrated good discrimination (area under the receiver operating characteristic [ROC] curve in the validation set for GR: 0.836, MD: 0.802, SD: 0.706, D/VS: 0.890) and calibration, both overall (Hosmer-Lemeshow test
    Language English
    Publishing date 2024-04-09
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645092-1
    ISSN 1557-9042 ; 0897-7151
    ISSN (online) 1557-9042
    ISSN 0897-7151
    DOI 10.1089/neu.2023.0529
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Comparative Effectiveness of Intracranial Pressure Monitoring on 6-Month Outcomes of Critically Ill Patients With Traumatic Brain Injury.

    Nattino, Giovanni / Gamberini, Lorenzo / Brissy, Obou / Carrara, Greta / Chesnut, Randall / Chiarini, Valentina / Chieregato, Arturo / Csomos, Akos / Fleming, Joanne M / Gradisek, Primoz / Kaps, Rafael / Kyprianou, Theodoros / Lazar, Isaac / Lemeshow, Stanley / Mikaszewska-Sokolewicz, Malgorzata / Paci, Giulia / Rossi, Carlotta / Temkin, Nancy / Xirouchaki, Nektaria /
    Giugni, Aimone / Bertolini, Guido

    JAMA network open

    2023  Volume 6, Issue 9, Page(s) e2334214

    Abstract: Importance: While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment ... ...

    Abstract Importance: While the relationship between persistent elevations in intracranial pressure (ICP) and poorer outcomes is well established for patients with traumatic brain injury (TBI), there is no consensus on how ICP measurements should drive treatment choices, and the effectiveness of ICP monitoring remains unknown.
    Objective: To evaluate the effectiveness of ICP monitoring on short- and mid-term outcomes of patients with TBI.
    Design, setting, and participants: CREACTIVE was a prospective cohort study that started in March 2014 and lasted 5 years. More than 8000 patients with TBI were enrolled at 83 intensive care units (ICUs) from 7 countries who joined the CREACTIVE Consortium. Patients with TBI who met the Brain Trauma Foundation guidelines for ICP monitoring were selected for the current analyses, which were performed from January to November 2022.
    Exposure: Patients who underwent ICP monitoring within 2 days of injury (exposure group) were propensity score-matched to patients who were not monitored or who underwent monitoring 2 days after the injury (control group).
    Main outcome and measure: Functional disability at 6 months as indicated by Glasgow Outcome Scale-Extended (GOS-E) score.
    Results: A total of 1448 patients from 43 ICUs in Italy and Hungary were eligible for analysis. Of the patients satisfying the ICP-monitoring guidelines, 503 (34.7%) underwent ICP monitoring (median [IQR] age: 45 years [29-61 years]; 392 males [77.9%], 111 females [22.1%]) and 945 were not monitored (median [IQR] age: 66 years [48-78 years]; 656 males [69.4%], 289 females [30.6%]). After matching to balance the variables, worse 6-month recovery was observed for monitored patients compared with nonmonitored patients (death/vegetative state: 39.2% vs 40.6%; severe disability: 33.2% vs 25.4%; moderate disability: 15.7% vs 14.9%; good recovery: 11.9% vs 19.1%, respectively; P = .005). Monitored patients received medical therapies significantly more frequently.
    Conclusions and relevance: In this cohort study, ICP monitoring was associated with poorer recovery and more frequent medical interventions with their relevant adverse effects. Optimizing the value of ICP monitoring for TBI requires further investigation on monitoring indications, clinical interventions, and management protocols.
    MeSH term(s) Male ; Female ; Humans ; Middle Aged ; Aged ; Cohort Studies ; Intracranial Pressure ; Prospective Studies ; Critical Illness/therapy ; Brain Injuries, Traumatic/complications
    Language English
    Publishing date 2023-09-05
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2023.34214
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury.

    Giugni, Aimone / Gamberini, Lorenzo / Carrara, Greta / Antiga, Luca / Brissy, Obou / Buldini, Virginia / Calamai, Italo / Csomos, Akos / De Luca, Alessandra / Ferri, Enrico / Fleming, Joanne M / Gradisek, Primoz / Kaps, Rafael / Kyprianou, Theodoros / Lagomarsino, Silvia / Lazar, Isaac / Martino, Costanza / Mikaszewska-Sokolewicz, Malgorzata / Montis, Andrea /
    Nardai, Gabor / Nattino, Giovanni / Nattino, Giuseppe / Paci, Giulia / Portolani, Laila / Xirouchaki, Nektaria / Chieregato, Arturo / Bertolini, Guido

    Scandinavian journal of trauma, resuscitation and emergency medicine

    2021  Volume 29, Issue 1, Page(s) 158

    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- ... ...

    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.
    MeSH term(s) Adult ; Brain Injuries, Traumatic ; Glasgow Coma Scale ; Glasgow Outcome Scale ; Hospitals ; Humans ; Intensive Care Units ; Neurosurgery
    Language English
    Publishing date 2021-11-02
    Publishing country England
    Document type Journal Article ; Observational Study
    ZDB-ID 2455990-8
    ISSN 1757-7241 ; 1757-7241
    ISSN (online) 1757-7241
    ISSN 1757-7241
    DOI 10.1186/s13049-021-00959-2
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: PROSAFE: a European endeavor to improve quality of critical care medicine in seven countries.

    Finazzi, Stefano / Paci, Giulia / Antiga, Luca / Brissy, Obou / Carrara, Greta / Crespi, Daniele / Csato, Gabor / Csomos, Akos / Duek, Or / Facchinetti, Sara / Fleming, Joanne / Garbero, Elena / Gianni, Massimo / Gradisek, Primoz / Kaps, Rafael / Kyprianou, Theodoros / Lazar, Isaac / Mikaszewska-Sokolewicz, Malgorzata / Mondini, Matteo /
    Nattino, Giovanni / Olivieri, Carlo / Poole, Daniele / Previtali, Claudio / Radrizzani, Danilo / Rossi, Carlotta / Skurzak, Stefano / Tavola, Mario / Xirouchaki, Nektaria / Bertolini, Guido

    Minerva anestesiologica

    2020  Volume 86, Issue 12, Page(s) 1305–1320

    Abstract: Background: Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive ... ...

    Abstract Background: Long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present PROSAFE, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. The project involved 343 ICUs in seven countries. All patients admitted to the ICU were eligible for data collection.
    Methods: The PROSAFE network collected data using the same electronic case report form translated into the corresponding languages. A complex, multidimensional validation system was implemented to ensure maximum data quality. Individual and aggregate reports by country, region, and ICU type were prepared annually. A web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database.
    Results: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. Organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. Conversely, ICU equipment differed, and patient outcomes showed wide variations among countries.
    Conclusions: PROSAFE is a permanent, stable, open access, multilingual database for clinical benchmarking, ICU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. Its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor.
    MeSH term(s) Adult ; Benchmarking ; Critical Care ; Databases, Factual ; Humans ; Intensive Care Units ; Italy
    Language English
    Publishing date 2020-12-18
    Publishing country Italy
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 123584-9
    ISSN 1827-1596 ; 0026-4717 ; 0375-9393
    ISSN (online) 1827-1596
    ISSN 0026-4717 ; 0375-9393
    DOI 10.23736/S0375-9393.20.14112-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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