ArticleScandinavian journal of trauma, resuscitation and emergency medicine2021
Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study.
Article in Scandinavian journal of trauma, resuscitation and emergency medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Transport and destination hospital for patients with suspected multiple and/or severe injuries - a systematic review and clinical practice guideline update.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026Pooled it
- Management and outcome of patients with traumatic brain injury treated in three major Nordic intensive care units: a comparative cohort study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Observational
- Impact of Admission Route on In-Hospital Mortality in Patients with Traumatic Brain Injury: A Retrospective Observational Study of a Single Major Trauma Center in South Korea.Journal of clinical medicine · 2026Article
- Article
- Impact of interhospital transport on outcome in traumatic epidural hematoma: experiences of a level-1 trauma center.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2025Article
- [Analysis of the main update content of the 7th edition of the American College of Surgeons on "Resources for Optimal Care of the Injured Patient (2022 Standards)"].Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences · 2024Article
- The analysis of aerobics intelligent fitness system for neurorobotics based on big data and machine learning.Heliyon · 2024Article
- Patients suffering traumatic brain injury: patient characteristics, prehospital triage, primary referral and mortality - A population-based follow-up study.Scandinavian journal of trauma, resuscitation and emergency medicine · 2024Observational
- Trauma systems in high socioeconomic index countries in 2050.Critical care (London, England) · 2024Review
- Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study.Journal of neurotrauma · 2023Article
- Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).World journal of emergency surgery : WJES · 2023Article
- Moderate and severe traumatic brain injury in general hospitals: a ten-year population-based retrospective cohort study in central Norway.Scandinavian journal of trauma, resuscitation and emergency medicine · 2022Article
- Traumatic brain injury: progress and challenges in prevention, clinical care, and research.The Lancet. Neurology · 2022Review
Corrections and comments
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Authors and funding
9 authors at 5 institutions in 4 countries.
Funding
Abstract
backgroundPrehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients.
methodsPatients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively.
resultsA total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78-1.69), nor with survival at discharge (1.05, 0.58-1.90).
conclusionsAcross Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation.
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