Characteristics, management and outcomes of patients with severe traumatic brain injury in Victoria, Australia compared to United Kingdom and Europe: A comparison between two harmonised prospective cohort studies

Eveline J.A. Wiegers*, Tony Trapani, the CENTER-TBI and OzENTER-TBI investigators and participants12, Collaboration groups: CENTER-TBI and OzENTER-TBI investigators and participants, Belinda J. Gabbe, Dashiell Gantner, Fiona Lecky, Andrew I.R. Maas, David K. Menon, Lynnette Murray, Jeffrey V. Rosenfeld, Shirley Vallance, Hester F. Lingsma, Ewout W. Steyerberg, D. James Cooper

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: The aim of this manuscript is to compare characteristics, management, and outcomes of patients with severe Traumatic Brain Injury (TBI) between Australia, the United Kingdom (UK) and Europe. Methods: We enrolled patients with severe TBI in Victoria, Australia (OzENTER-TBI), in the UK and Europe (CENTER-TBI) from 2015 to 2017. Main outcome measures were mortality and unfavourable outcome (Glasgow Outcome Scale Extended <5) 6 months after injury. Expected outcomes were compared according to the IMPACT-CT prognostic model, with observed to expected (O/E) ratios and 95% confidence intervals. Results: We included 107 patients from Australia, 171 from UK, and 596 from Europe. Compared to the UK and Europe, patients in Australia were younger (median 32 vs 44 vs 44 years), a larger proportion had secondary brain insults including hypotension (30% vs 17% vs 21%) and a larger proportion received ICP monitoring (75% vs 74% vs 58%). Hospital length of stay was shorter in Australia than in the UK (median: 17 vs 23 vs 16 days), and a higher proportion of patients were discharged to a rehabilitation unit in Australia than in the UK and Europe (64% vs 26% vs 28%). Mortality overall was lower than expected (27% vs 35%, O/E ratio 0.77 [95% CI: 0.64 – 0.87]. O/E ratios were comparable between regions for mortality in Australia 0.86 [95% CI: 0.49–1.23] vs UK 0.82 [0.51–1.15] vs Europe 0.76 [0.60–0.87]). Unfavourable outcome rates overall were in line with historic expectations (O/E ratio 1.32 [0.96-1.68] vs 1.13 [0.84-1.42] vs 0.96 [0.85-1.09]). Conclusions: There are major differences in case-mix between Australia, UK, and Europe; Australian patients are younger and have a higher rate of secondary brain insults. Despite some differences in management and discharge policies, mortality was less than expected overall, and did not differ between regions. Functional outcomes were similar between regions, but worse than expected, emphasizing the need to improve treatment for patients with severe TBI.

Original languageEnglish
Pages (from-to)2576-2587
Number of pages12
Issue number9
Early online date11 Apr 2021
Publication statusPublished - 1 Sept 2021

Bibliographical note

Funding Information:
This research was funded by the European Commission 7th Framework program (602150), the Australian Health and Medical Research Council (NHMRC 1074181) and the Transport Accident Commission Victoria Australia (ISCRR N-14- 129). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), from Integra LifeSciences Corporation (USA) and from Neurotrauma Sciences (USA). The funders had no role in the design of the study and collection, analysis, interpretation of data and in writing the manuscript.

Funding Information:
AIRM declares consulting fees from PresSura Neuro, Integra Life Sciences, and NeuroTrauma Sciences. DKM reports grants from the UK National Institute for Health Research, during the conduct of the study; grants, personal fees, and non-financial support from GlaxoSmithKline; personal fees from Neurotrauma Sciences, Lantmaanen AB, Pressura, and Pfizer, outside of the submitted work. ES reports personal fees from Springer, during the conduct of the study. DJC is an Australian NHMRC Practitioner Fellow and reports grants from the NHMRC and consulting fees to Monash University from PresSura Neuro. All other authors declare no competing interests.

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

Publisher Copyright:
© 2021 The Authors


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