title: 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.
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 at the 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 and 15 and 26 (38%) defined it as a GCS score between 14 and 15. At the ED various guidelines for the use of head computed tomography (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, whereas 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 the 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.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.|Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Kelly A
authors.initials: KA
authors.lastname: Foks
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Maryse C
authors.initials: MC
authors.lastname: Cnossen
authors.affiliation: Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik W J
authors.initials: DWJ
authors.lastname: Dippel
authors.affiliation: Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
authors.forename: Andrew I R
authors.initials: AIR
authors.lastname: Maas
authors.affiliation: Division of Anaesthesia, University of Cambridge/Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Menon
authors.affiliation: Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Joukje
authors.initials: J
authors.lastname: van der Naalt
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
keywords: admission; emergency department; guideline; survey; traumatic brain injury