Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI)
CENTER-TBI is a large European project that aims to improve the care for patients with Traumatic Brain Injury (TBI).
It forms part of the larger global initiative InTBIR: International Initiative for Traumatic Brain Injury Research with projects currently ongoing in Europe, the USA and Canada.
CENTER-TBI brings the newest technologies and many of the world's leading TBI experts together in a much needed effort to tackle the silent epidemic of TBI. International and multidisciplinary collaboration are key elements to the project in which past dogmas will be left behind and innovative approaches undertaken. As Coordinators of CENTER-TBI we are proud to lead this generationally unique project.
They anticipate that CENTER-TBI will revolutionize our view of leading TBI to more effective and efficient therapy, improved health care at both individual and population based levels, and better outcomes at lower costs.
It should provide novel multidimensional approaches to Traumatic Brain Injury (TBI) characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research.
Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management 1).
Foks et al. aimed to study variability between management policies for traumatic brain injury (TBI) patients at the ED and hospital ward across Europe. Centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study received questionnaires about different phases of TBI care. These questionnaires included 71 questions about TBI management at the ED and at the hospital ward.
They found differences in how centers defined mild traumatic brain injury mTBI. For example, 40 centers (59%) defined mTBI as a Glasgow Coma Scale (GCS) score between 13-15 and 26 (38%) as a GCS score between 14-15. At the ED various guidelines for the use of head CT in mTBI patients were used; 32 centers (49%) used national guidelines, 10 centers (15%) local guidelines and 14 centers (21%) used no guidelines at all. Also differences in indication for admission between centers were found. After ED discharge, 7 centers (10%) scheduled a routine follow-up appointment, while 38 (54%) did so only after ward admission. In conclusion, large between-center variation exists in policies for diagnostics, admission and discharge decisions in patients with mTBI at the ED and in hospital. Guidelines are not always operational in centers, and reported policies systematically diverge from what is recommended in those guidelines. The results of this study may be useful in the understanding of mTBI care in Europe and show the need for further studies on the effectiveness of different policies on outcome 2).
The aim of study was to describe current approaches and to quantify variability between European intensive care units (ICU)s in patients with traumatic brain injury (TBI). Therefore, Huijben et al. conducted a provider profiling survey as part of the 'Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury' (CENTER-TBI) study. The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel. For this study, they used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thrombosis (DVT) prophylaxis. Sixty-six centers completed the ICU questionnaire. For ICU-patients, half of the centers (N= 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated a Hb-TL between 70 and 90 g/l and 38 centers (59%) above 90 g/l. To treat trauma related hemostatic abnormalities the use of fresh frozen plasma (N= 48; 73%) or platelets (N= 34; 52%) was most often reported, followed by the supplementation of vitamin K (N= 26; 39%). Most centers reported using DVT prophylaxis with anticoagulants frequently or always (N= 62; 94%). In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 hours after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 hours increased to 29 (46%). Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management. The results provide a baseline for the CENTER-TBI study and the large between-center variation indicates multiple opportunities for comparative effectiveness research 3).