Can We Cluster ICU Treatment Strategies for Traumatic Brain Injury by Hospital Treatment Preferences?

Iris E. Ceyisakar*, Jilske Huijben, CENTER TBI Participants and Investigators, Andrew I.R. Maas, Hester F. Lingsma, Nikki van Leeuwen

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Background: In traumatic brain injury (TBI), large between-center differences in treatment and outcome for patients managed in the intensive care unit (ICU) have been shown. The aim of this study is to explore if European neurotrauma centers can be clustered, based on their treatment preference in different domains of TBI care in the ICU. Methods: Provider profiles of centers participating in the Collaborative European Neurotrauma Effectiveness Research in TBI study were used to assess correlations within and between the predefined domains: intracranial pressure monitoring, coagulation and transfusion, surgery, prophylactic antibiotics, and more general ICU treatment policies. Hierarchical clustering using Ward’s minimum variance method was applied to group data with the highest similarity. Heat maps were used to visualize whether hospitals could be grouped to uncover types of hospitals adhering to certain treatment strategies. Results: Provider profiles were available from 66 centers in 20 different countries in Europe and Israel. Correlations within most of the predefined domains varied from low to high correlations (mean correlation coefficients 0.2–0.7). Correlations between domains were lower, with mean correlation coefficients of 0.2. Cluster analysis showed that policies could be grouped, but hospitals could not be grouped based on their preference. Conclusions: Although correlations between treatment policies within domains were found, the failure to cluster hospitals indicates that a specific treatment choice within a domain is not a proxy for other treatment choices within or outside the domain. These results imply that studying the effects of specific TBI interventions on outcome can be based on between-center variation without being substantially confounded by other treatments. Trial registration: We do not report the results of a health care intervention.

Original languageEnglish
Pages (from-to)846-856
Number of pages11
JournalNeurocritical Care
Issue number3
Early online date6 Dec 2021
Publication statusPublished - Jun 2022

Bibliographical note

Funding Information:
Hungarian Brain Research Program - Grant No. KTIA_13_NAP-A-II/8, University of Pécs, Pécs, Hungary 76

Funding Information:
The authors thank all clinical and research staff at the CENTER-TBI sites for completing the provider profiling questionnaires. Data used in preparation of this manuscript were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission 7th Framework program (602150).

Funding Information:
The authors’ work on this study is partly funded by the European Union seventh Framework Program (grant 602150) for Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Additional support for CENTER-TBI was obtained from the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).

Publisher Copyright:
© 2021, The Author(s).


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