Casemix, management, and mortality of patients receiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Issue 5 (May 2022)

• Record Type: Journal Article
• Authors: Clark, David; Joannides, Alexis; Adeleye, Amos Olufemi; Bajamal, Abdul Hafid; Bashford, Tom; Biluts, Hagos; Budohoski, Karol; Ercole, Ari; Fernández-Méndez, Rocío; Figaji, Anthony; Gupta, Deepak Kumar; Härtl, Roger; Iaccarino, Corrado; Khan, Tariq; Laeke, Tsegazeab; Rubiano, Andrés; Shabani, Hamisi K; Sichizya, Kachinga; Tewari, Manoj; Tirsit, Abenezer; Thu, Myat; Tripathi, Manjul; Trivedi, Rikin; Devi, Bhagavatula Indira; Servadei, Franco; Menon, David; Kolias, Angelos; Hutchinson, Peter; Abbas, Ghayur; Abdallah, Omar Ibrahim; Abdel-Lateef, Ahmed; Abdifatah, Khalif; Abdullateef, Awfa; Abeygunaratne, Ruvini; Aboellil, Mostafa; Adam, Abass; Adams, Robert; Adeleye, Amos; Adeolu, Augustine; Adji, Novan Krisno; Afianti, Nur; Agarwal, Sudarsan; Aghadi, Ifeanyi Kene; Aguilar, Paúl Martín Méndez; Ahmad, Syeda Rida; Ahmed, Daniyal; Ahmed, Nafees; Aizaz, Haider; Aji, Yunus Kuntawi; Alamri, Alex; Alberto, Augusto Jacinto Mussindo; Alcocer, Luis Alcocer; Alfaro, Lesly Gonzales; Al-Habib, Amro; Alhourani, Ahmad; Ali, Syed Muhammad Rafay; Alkherayf, Fahad; AlMenabbawy, Ahmed; Alshareef, Aliyah; Aminullah, Muhammad Adil s/o; Amjad, Madeha; Amorim, Robson Luis Oliveira de; Anbazhagan, Sathiaprabhu; Andrade, Almir; Antar, Waleed; Anyomih, Theophilus T.K.; Aoun, Salah; Apriawan, Tedy; Armocida, Daniele; Arnold, Paul; Arraez, Miguel; Assefa, Temesgen; Asser, Andres; Athiththan, S.P.; Attanayake, Deepal; Aung, Maung Maung; Avi, Allan; Ayala, Victor Enrique Antolinez; Azab, Mohammed; Azam, Gaousul; Azharuddin, Mohd; Badejo, Olukemi; Badran, Mohamed; Baig, Azam Ali; Baig, Rehman Ali; Bajaj, Ankur; Baker, Paul; Bala, Renu; Balasa, Artur; Balchin, Ross; Balogun, James; Ban, Vin Shen; Bandi, Bharath Kumar Reddy; Bandyopadhyay, Soham; Bank, Matthew; Barthelemy, Ernest; Bashir, Mohammed Talha; Basso, Luciano Silveira; Basu, Surajit; Batista, Auricelio; Bauer, Marlies; Bavishi, Devi; Beane, Abi; Bejell, Shmuel; Belachew, Anteneh; Belli, Antonio; Belouaer, Amani; Bendahane, Najia El Abbadi; Benjamin, Okanga; Benslimane, Youssef; Benyaiche, Chaymae; Bernucci, Claudio; Berra, Luigi Valentino; Bhebe, Arnold; Bimpis, Alexios; Blanaru, Diana; Bonfim, Jean Claude; Borba, Luis A B; Borcek, Alp Ozgun; Borotto, Erika; Bouhuwaish, Ahmad Elmabri Mohammad; Bourilhon, Facundo; Brachini, Gioia; Breedon, Joshua; Broger, Maximilian; Brunetto, Giacoma Maria Floriana; Bruzzaniti, Placido; Budohoska, Natalia; Burhan, Hira; Calatroni, Maximiliano Luis; Camargo, Catherine; Cappai, Pier Francesco; Cardali, Salvatore Massimiliano; Castaño-Leon, Ana M; Cederberg, David; Celaya, Mikel; Cenzato, Marco; Challa, Lakshmi Madhavi; Charest, Dhanny; Chaurasia, Bipin; Chenna, Rabah; Cherian, Iype; Ching'o, Juliana Henry; Chotai, Tejas; Choudhary, Ajay; Choudhary, Nabeel; Choumin, Florence; Cigic, Tomislav; Ciro, Juan; Conti, Carlo; Corrêa, Antônio Carlos de Souza; Cossu, Giulia; Couto, Maíra Piani; Cruz, Aurora; D'Silva, Divya; D'Aliberti, Giuseppe Antonio; Dampha, Lamin; Daniel, Roy Thomas; Dapaah, Andrew; Darbar, Aneela; Dascalu, Gabriel; Dauda, Happy Amos; Davies, Owain; Delgado-Babiano, Andrea; Dengl, Markus; Despotovic, Marko; Devi, Indira; Dias, Celeste; Dirar, Mohamed; Dissanayake, Melina; Djimbaye, Hananiah; Dockrell, Simon; Dolachee, Ali; Dolgopolova, Julija; Dolgun, Muge; Dow, Abdalrouf; Drusiani, Davide; Dugan, Artjom; Duong, Dinh Tuan; Duong, Trung Kien; Dziedzic, Tomasz; Ebrahim, Ali; El Fatemi, Nizar; El Helou, Antonios El; El Maaqili, Rachid El; El Mostarchid, Brahim El; El Ouahabi, Abdessamad El; Elbaroody, Mohammad; El-Fiki, Ahmed; El-Garci, Ahmed; El-Ghandour, Nasser M.F.; Elhadi, Muhammed; Elleder, Vanessa; Elrais, Safa; El-shazly, Mohamed; Elshenawy, Mohamed; Elshitany, Hesham; El-Sobky, Omar; Emhamed, Marwa; Enicker, Basil; Erdogan, Onur; Ertl, Sebastian; Esene, Ignatius; Espinosa, Omar Ocampo; Fadalla, Tarig; Fadelalla, Mohammed; Faleiro, Rodrigo Moreira; Fatima, Nida; Fawaz, Charbel; Fentaw, Assefa; Fernandez, Carla Eiriz; Ferreira, Ana; Ferri, Francesco; Figaji, Tony; Filho, Emerson L B; Fin, Loic; Fisher, Benjamin; Fitra, Fitra; Flores, Alexis Palpan; Florian, Ioan Stefan; Fontana, Vincenzo; Ford, Lauren; Fountain, Daniel; Frade, Jose Maria Roda; Fratto, Antonio; Freyschlag, Christian; Gabin, Aranzazu Sánchez; Gallagher, Clare; Ganau, Mario; Gandia-Gonzalez, Maria Luisa; Garcia, Andoni; Garcia, Borja Hernandez; Garusinghe, Sanjeewa; Gebreegziabher, Biniam; Gelb, Adrian; George, Jerome St; Germanò, Antonino Francesco; Ghetti, Ilaria; Ghimire, Prajwal; Giammarusti, Alessandro; Gil, Jose Luis; Gkolia, Panagiota; Godebo, Yoseph; Gollapudi, Prakash Rao; Golubovic, Jagos; Gomes, Jeremias Fernando; Gonzales, Javier; Gormley, William; Gots, Alexander; Gribaudi, Giulia Letizia; Griswold, Dylan; Gritti, Paolo; Grobler, Ruan; Gunawan, Rudy; Hailemichael, Birhanu; Hakkou, Elmehdi; Haley, Mark; Hamdan, Alhafidz; Hammed, Ali; Hamouda, Waeel; Hamzah, Nurul Ashikin; Han, Nyein Latt; Hanalioglu, Sahin; Haniffa, Rashan; Hanko, Martin; Hanrahan, John; Hardcastle, Timothy; Hassani, Fahd Derkaoui; Heidecke, Volkmar; Helseth, Eirik; Hernández-Hernández, Miguel Ángel; Hickman, Zachary; Hoang, Le Minh Chau; Hollinger, Alexa; Horakova, Lenka; Hossain-Ibrahim, Kismet; Hou, Boru; Hoz, Samer; Hsu, Janine; Hunn, Martin; Hussain, Madiha; Iacopino, Giorgia; Ideta, Mylena Miki Lopes; Iglesias, Irene; Ilunga, Ali; Imtiaz, Nafiz; Islam, Rafiza; Ivashchenko, Serge; Izirouel, Karim; Jabal, Mohamed Sobhi; Jabal, Soubhi; Jabang, John Nute; Jamjoom, Aimun; Jan, Irfan; Jarju, Landing BM; Javed, Saad; Jelaca, Bojan; Jhawar, Sukhdeep Singh; Jiang, Ting Ting; Jimenez, Fernando; Jiris, Jorge; Jithoo, Ron; Johnson, Walt; Joseph, Mathew; Joshi, Rameshman; Junttila, Eija; Jusabani, Mubashir; Kache, Stephen Akau; Kadali, Satyavara Prasad; Kalkmann, Gabriela F; Kamboh, Usman; Kandel, Hitham; Karakus, Ahmet Kamil; Kassa, Mengistu; Katila, Ari; Kato, Yoko; Keba, Martin; Kehoe, Kristy; Kertmen, Huseyin Hayri; Khafaji, Soha; Khajanchi, Monty; Khan, Mohammed; Khan, Muhammad Mukhtar; Khan, Sohail Daud; Khizar, Ahtesham; Khriesh, Amir; Kierońska, Sara; Kisanga, Paul; Kivevele, Boniface; Koczyk, Kacper; Koerling, Anna-Lucia; Koffenberger, Danielle; Kõiv, Kennet; Kõiv, Leho; Kolarovszki, Branislav; König, Marton; Könü-Leblebicioglu, Dilek; Koppala, Santhoshi Devi; Korhonen, Tommi; Kostkiewicz, Boguslaw; Kostyra, Kacper; Kotakadira, Srinivas; Kotha, Arjun Reddy; Kottakki, Madhu Narayana Rao; Krajcinovic, Nenad; Krakowiak, Michal; Kramer, Andreas; Krishnamoorthy, Selvamuthukumaran; Kumar, Ashok; Kumar, Pankaj; Kumar, Pradhumna; Kumarasinghe, Nilaksha; Kuncha, Gowtham; Kutty, Raja K.; Laeke, Tsegazeab; Lafta, Ghazwan; Lammy, Simon; Lapolla, Pierfrancesco; Lardani, Jacopo; Lasica, Nebojsa; Lastrucci, Giancarlo; Launey, Yoann; Lavalle, Laura; Lawrence, Tim; Lazaro, Albert; Lebed, Vitalii; Leinonen, Ville; Lemeri, Lawrence; Levi, Leon; Lim, Jia Yi; Lim, Xiao Yi; Linares-Torres, Jorge; Lippa, Laura; Lisboa, Lurdes; Liu, Jinfang; Liu, Ziyuan; Lo, William B; Lodin, Jan; Loi, Federico; Londono, Daniella; Lopez, Pedro Antonio Gomez; López, Cristina Barceló; Lotbiniere-Bassett, Madeleine De; Lulens, Rihards; Luna, Facundo Hector; Luoto, Teemu; M.V., Vijaya Sekhar; Mabovula, Ndyebo; MacAllister, Matthew; Macie, Alcina Americo; Maduri, Rodolfo; Mahfoud, Moufid; Mahmood, Ashraf; Mahmoud, Fathia; Mahoney, Dominic; Makhlouf, Wissam; Malcolm, George; Malomo, Adefolarin; Malomo, Toluyemi; Mani, Manoranjitha Kumari; Marçal, Tomás Gazzinelli; Marchello, Jacopo; Marchesini, Nicolò; Marhold, Franz; Marklund, Niklas; Martín-Láez, Rubén; Mathaneswaran, Vickneswaran; Mato-Mañas, David José; Maye, Helen; McLean, Aaron Lawson; McMahon, Catherine; Mediratta, Saniya; Mehboob, Mehreen; Meneses, Alisson; Mentri, Nesrine; Mersha, Hagos; Mesa, Ana Milena; Meyer, Cristy; Millward, Christopher; Mimbir, Salomao Amone; Mingoli, Andrea; Mishra, Parashruram; Mishra, Tejesh; Misra, Basant; Mittal, Siddharth; Mohammed, Imran; Moldovan, Ioana; Molefe, Masechaba; Moles, Alexis; Moodley, Preston; Morales, Mario Augusto Narváez; Morgan, Lucy; Morillo, German Del Castillo; Moustafa, Wahab; Moustakis, Nikolaos; Mrichi, Salma; Munjal, Satya Shiva; Muntaka, Abdul-Jalilu Mohammed; Naicker, Denver; Nakashima, Paulo E H; Nandigama, Pratap Kumar; Nash, Samantha; Negoi, Ionut; Negoita, Valetina; Neupane, Samundra; Nguyen, Manh Hung; Niantiarno, Fajar Herbowo; Noble, Abbi; Nor, Mohd Arman Muhamad; Nowak, Blazej; Oancea, Andrei; O'Brien, Frazer; Okere, Oghenekevwe; Olaya, Sandra; Oliveira, Leandro; Oliveira, Louise Makarem; Omar, Fatma; Ononeme, Okezi; Opšenák, René; Orlandini, Simone; Osama, Alrobah; Osei-Poku, Dorcas; Osman, Haytham; Otero, Alvaro; Ottenhausen, Malte; Otzri, Shuli; Outani, Oumaima; Owusu, Emmanuel Abem; Owusu-Agyemang, Kevin; Ozair, Ahmad; Ozoner, Baris; Paal, Elli; Paiva, Mauro Sérgio; Paiva, Wellingson; Pandey, Sharad; Pansini, Gastone; Pansini, Luigi; Pantel, Tobias; Pantelas, Nikolaos; Papadopoulos, Konstantinos; Papic, Vladimir; Park, Kee; Park, Nick; Paschoal, Eric Homero Albuquerque; Paschoalino, Mylla Christie de Oliveira; Pathi, Rajesh; Peethambaran, Anilkumar; Pereira, Thiago Andrade; Perez, Irene Panero; Pérez, Claudio José Piqueras; Periyasamy, Tamilanandh; Peron, Stefano; Phillips, Michael; Picazo, Sofía Sotos; Pinar, Ertugrul; Pinggera, Daniel; Piper, Rory; Pirakash, Pathmanesan; Popadic, Branko; Posti, Jussi P.; Prabhakar, Rajmohan Bhanu; Pradeepan, Sivanesalingam; Prasad, Manjunath; Prieto, Paola Calvachi; Prince, Ron; Prontera, Andrea; Provaznikova, Eva; Quadros, Danilo; Quintero, Nezly Jadid Romero; Qureshi, Mahmood; Rabiel, Happiness; Rada, Gabriel; Ragavan, Sivagnanam; Rahman, Jueria; Ramadhan, Omar; Ramaswamy, Padma; Rashid, Sakina; Rathugamage, Jagath; Rätsep, Tõnu; Rauhala, Minna; Raza, Asif; Reddycherla, Naga Raju; Reen, Linus; Refaat, Mohamed; Regli, Luca; Ren, Haijun; Ria, Antonio; Ribeiro, Thales Francisco; Ricci, Alessandro; Richterová, Romana; Ringel, Florian; Robertson, Faith; Rocha, Catarina Mayrink Siqueira Cabral; Rogério, Juvenal de Souza; Romano, Adan Anibal; Rothemeyer, Sally; Rousseau, Gail Rousseau Gail; Roza, Ranette; Rueda, Kevin David Farelo; Ruiz, Raiza; Rundgren, Malin; Rzeplinski, Radoslaw; S.Chandran, Raj; Sadayandi, Ramesh Andi; Sage, William; Sagerer, André Norbert Josef; Sakar, Mustafa; Salami, Mohcine; Sale, Danjuma; Saleh, Youssuf; Sánchez-Viguera, Cristina; Sandila, Saning'o; Sanli, Ahmet Metin; Santi, Laura; Santoro, Antonio; Santos, Aieska Kellen Dantas Dos; Santos, Samir Cezimbra dos; Sanz, Borja; Sapkota, Shabal; Sasidharan, Gopalakrishnan; Sasillo, Ibrahim; Satoskar, Rajeev; Sayar, Ali Caner; Sayee, Vignesh; Scheichel, Florian; Schiavo, Felipe Lourenzon; Schupper, Alexander; Schwarz, Andreas; Scott, Teresa; Seeberger, Esther; Segundo, Claudionor Nogueira Costa; Seidu, Anwar Sadat; Selfa, Antonio; Selmi, Nazan Has; Selvarajah, Claudiya; Şengel, Necmiye; Seule, Martin; Severo, Luiz; Shah, Purva; Shahzad, Muhammad; Shangase, Thobekile; Sharma, Mayur; Shiban, Ehab; Shimber, Emnet; Shokunbi, Temitayo; Siddiqui, Kaynat; Sieg, Emily; Siegemund, Martin; Sikder, Shahidur Rahman; Silva, Ana Cristina Veiga; Silva, Ana; Silva, Pedro Alberto; Singh, Deepinder; Skadden, Carly; Skola, Josef; Skouteli, Eirini; Słoniewski, Pawel; Smith, Brandon; Solanki, Guirish; Solla, Davi Fontoura; Solla, Davi; Sonmez, Ozcan; Sönmez, Müge; Soon, Wai Cheong; Stefini, Roberto; Stienen, Martin Nikolaus; Stoica, Bogdan; Stovell, Matthew; Suarez, Maria Natalia; Sulaiman, Alaa; Suliman, Mazin; Sulistyanto, Adi; Sulubulut, Şeniz; Sungailaite, Sandra; Surbeck, Madlen; Szmuda, Tomasz; Taddei, Graziano; Tadele, Abraham; Taher, Ahmed Saleh Ahmed; Takala, Riikka; Talari, Krishna Murthy; Tan, Bih Huei; Tariciotti, Leonardo; Tarmohamed, Murad; Taroua, Oumayma; Tatti, Emiliano; Tenovuo, Olli; Tetri, Sami; Thakkar, Poojan; Thango, Nqobile; Thatikonda, Satish Kumar; Thesleff, Tuomo; Thomé, Claudius; Thornton, Owen; Timmons, Shelly; Timoteo, Eva Ercilio; Tingate, Campbell; Tliba, Souhil; Tolias, Christos; Toman, Emma; Torres, Ivan; Torres, Luis; Touissi, Youness; Touray, Musa; Tropeano, Maria Pia; Tsermoulas, Georgios; Tsitsipanis, Christos; Turkoglu, Mehmet Erhan; Uçkun, Özhan Merzuk; Ullman, Jamie; Ungureanu, Gheorghe; Urasa, Sarah; Ur-Rehman, Obaid; Uysal, Muhammed; Vakis, Antonios; Valeinis, Egils; Valluru, Vaishali; Vannoy, Debby; Vargas, Pablo; Varotsis, Phillipos; Varshney, Rahul; Vats, Atul; Veljanoski, Damjan; Venturini, Sara; Verma, Abhijit; Villa, Clara; Villa, Genaro; Villar, Sofia; Villard, Erin; Viruez, Antonio; Voglis, Stefanos; Vulekovic, Petar; Wadanamby, Saman; Wagner, Katherine; Walshe, Rebecca; Walter, Jan; Waseem, Marriam; Whitworth, Tony; Wijeyekoon, Ruwani; Williams, Adam; Wilson, Mark; Win, Sein; Winarso, Achmad Wahib Wahju; Ximenes, Abraão Wagner Pessoa; Yadav, Anurag; Yadav, Dipak; Yakoub, Kamal Makram; Yalcinkaya, Ali; Yan, Guizhong; Yaqoob, Eesha; Yepes, Carlos; Yılmaz, Ayfer Nazmiye; Yishak, Betelehem; Yousuf, Farhat Basheer; Zahari, Muhammad Zamzuri; Zakaria, Hussein; Zambonin, Diego; Zavatto, Luca; Zebian, Bassel; Zeitlberger, Anna Maria; Zhang, Furong; Zheng, Fengwei; Ziga, Michal;
• Is Part Of: Lancet neurology. Volume 21:Issue 5(2022)
• Page Start: 438
• Page End: 449
• Publication Date: 2022-05
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Nervous System Diseases -- Periodicals; Neurologie -- Périodiques; Neurology; Electronic journals; Periodicals; 616.805
• DOI: 10.1016/S1474-4422(22)00037-0
• Languages: English
• ISSNs: 1474-4422

Abstract

Summary: Background: Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. Methods: We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)—a composite of life expectancy, education, and income measures—into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. Findings: Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24–51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34–69) and the youngest in the low HDI tier (median 28 years, IQR 20–38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6–32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55–5·2) and high HDI tier (2·26, 1·23–4·15), but not the low HDI tier (1·66, 0·61–4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17–2·49). Interpretation: Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. Funding: National Institute for Health Research Global Health Research Group.