| Autor: |
Nattino G; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy., Lemeshow S; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA., Carrara G; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy., Rossi C; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy., Brissy O; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy., Chieregato A; Neurointensive Care Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy., Csomos A; Hungarian Army Medical Center, Budapest, Hungary., Fleming JM; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy., Giugni A; Anesthesia, Intensive Care and Prehospital Emergency, Maggiore Hospital, Bologna, Italy., Gradisek P; Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia.; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia., Kaps R; General Hospital Novo Mesto, Novo Mesto, Slovenia., Kyprianou T; University of Nicosia Medical School, Nicosia, Cyprus.; University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK., Lazar I; Pediatric Intensive Care Unit, Soroka Medical Center and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel., Mikaszewska-Sokolewicz M; Clinic of Anaesthesia and Intensive Care, Medical University of Warsaw, Warsaw, Poland., Paci G; Hospital Nursing Management, AUSL Romagna, Maurizio Bufalini Hospital, Cesena, Italy., Xirouchaki N; University Hospital of Heraklion, Crete, Greece., Bertolini G; Laboratory of Clinical Epidemiology, Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Ranica, Bergamo, Italy. |
| Abstrakt: |
Assessing quality of care is essential for improving the management of patients experiencing traumatic brain injury (TBI). This study aimed at devising a rigorous framework to evaluate the quality of TBI care provided by intensive care units (ICUs) and applying it to the Collaborative Research on Acute Traumatic Brain Injury in Intensive Care Medicine in Europe (CREACTIVE) consortium, which involved 83 ICUs from seven countries. The performance of the centers was assessed in terms of patients' outcomes, as measured by the 6-month Glasgow Outcome Scale-Extended (GOS-E). To account for the between-center differences in the characteristics of the admitted patients, we developed a multinomial logistic regression model estimating the probability of a four-level categorization of the GOS-E: good recovery (GR), moderate disability (MD), severe disability (SD), and death or vegetative state (D/VS). A total of 5928 patients admitted to the participating ICUs between March 2014 and March 2019 were analyzed. The model included 11 predictors and demonstrated good discrimination (area under the receiver operating characteristic [ROC] curve in the validation set for GR: 0.836, MD: 0.802, SD: 0.706, D/VS: 0.890) and calibration, both overall (Hosmer-Lemeshow test p value: 0.87) and in several subgroups, defined by prognostically relevant variables. The model was used as a benchmark for assessing quality of care by comparing the observed number of patients experiencing GR, MD, SD, and D/VS to the corresponding numbers expected in each category by the model, computing observed/expected (O/E) ratios. The four center-specific ratios were assembled with polar representations and used to provide a multidimensional assessment of the ICUs, overcoming the loss of information consequent to the traditional dichotomizations of the outcome in TBI research. The proposed framework can help in identifying strengths and weaknesses of current TBI care, triggering the changes that are necessary to improve patient outcomes. |
