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      Management of mild traumatic brain injury at the emergency department and hospital admission in Europe: A survey of 71 neurotrauma centers participating in the CENTER-TBI study.

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          Abstract

          Previous studies have indicated that there is no consensus about management of mild traumatic brain injury (mTBI) at the emergency department (ED) and during hospital admission. We aim to study variability between management policies for 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. We found differences in how centers defined 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.

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          Author and article information

          Journal
          J. Neurotrauma
          Journal of neurotrauma
          Mary Ann Liebert Inc
          1557-9042
          0897-7151
          Apr 11 2017
          Affiliations
          [1 ] Erasmus MC, 6993, Public Health , PO BOX 2040 , Rotterdam, Netherlands , 3000 CA ; k.foks@erasmusmc.nl.
          [2 ] Erasmus Medical Center, Public Health , Wytemaweg 80 , 3015CN Rotterdam , P.O. Box 2040 , Rotterdam , Netherlands , 3015 CN ; m.c.cnossen@erasmusmc.nl.
          [3 ] Erasmus MC, 6993, Neurology, Rotterdam, Zuid-Holland, Netherlands ; d.dippel@erasmusmc.nl.
          [4 ] University Hospital Antwerp, Neurosurgery , Wilrijkstraat 10 , Edegem, Belgium , 2650.
          [5 ] Netherlands ; Andrew.Maas@uza.be.
          [6 ] University of Cambridge, Head, Division of Anaesthesia , Box 93, Addenbrooke's Hospital , Hills Road , Cambridge, Cambs, United Kingdom of Great Britain and Northern Ireland , CB2 2QQ ; dkm13@cam.ac.uk.
          [7 ] University Medical Center Groningen, Neurology , PO box 30001 , Groningen, Netherlands , 9700RB.
          [8 ] Netherlands ; j.van.der.naalt@umcg.nl.
          [9 ] Erasmus MC, Public Health , PO Box 1738 , Rotterdam, Netherlands , 3000 DR ; e.steyerberg@erasmusmc.nl.
          [10 ] Erasmus MC, Public Health , Room AE-138 , PO BOX 2040 , Rotterdam, Netherlands , 3000 CA.
          [11 ] Netherlands ; h.lingsma@erasmusmc.nl.
          [12 ] Erasmus MC, University Medical Center Rotterdam, Public Health, Rotterdam, Netherlands ; s.polinder@erasmusmc.nl.
          Article
          10.1089/neu.2016.4919
          28398105

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