Table 2.
Acute care provision, outcomes, and process parameters*
| Europe (n = 22849) | India (n = 3904) | P-value | |
|---|---|---|---|
|
Type of emergency care
|
|
|
<0.001 |
| No professional care |
5259 (23) |
3678 (94) |
|
| Ambulance (without physician) |
12510 (55) |
223 (6) |
|
| Helicopter service |
893 (4) |
1 (0) |
|
| Mobile medical team |
3800 (17) |
2 (0) |
|
| Not applicable |
246 (1) |
0 (0) |
|
| Unknown/missing |
141 (1) |
0 (0) |
|
|
Pre-hospital intubation in severe TBI patients
|
|
|
<0.001 |
| No |
586 (35) |
819 (95) |
|
| Yes |
1062 (64) |
48 (6) |
|
| Unknown/missing |
13 (1) |
0 (0) |
|
|
Pre-hospital ventilation in severe TBI patients
|
|
|
<0.001 |
| No |
659 (40) |
828 (96) |
|
| Yes |
967 (58) |
39 (4) |
|
| Unknown/missing |
35 (2) |
0 (0) |
|
|
Transport to study hospital
|
|
|
<0.001 |
| Primary referral |
19862 (87) |
2423 (62) |
|
| Secondary referral from other hospital |
2927 (13) |
1481 (38) |
|
| Unknown/missing |
60 (0) |
0 (0) |
|
|
Time (hours) from injury to study hospital, MD (IQR)
|
1.6 (0.8–5.7) |
3.9 (1.6–9.8) |
<0.001 |
|
Time (hours) from injury to first CT-scan, MD (IQR)
|
2.9 (1.7–7.0) |
4.1 (2.3–10.0) |
<0.001 |
|
Care pathway
|
|
|
<0.001 |
| ED |
9839 (43) |
1258 (32) |
|
| Admission |
8571 (38) |
1248 (32) |
|
| ICU |
4372 (19) |
1398 (36) |
|
| Unknown/missing |
67 (0) |
0 (0) |
|
|
Key emergency intervention† |
|
|
<0.001 |
| No |
20029 (88) |
2848 (73) |
|
| Yes |
2496 (11) |
1056 (27) |
|
| Unknown/missing |
324 (1) |
0 (0) |
|
|
Intracranial surgery
|
|
|
|
| Craniotomy for haematoma |
|
|
<0.001 |
|
No
|
22019 (96) |
3591 (92) |
|
|
Yes
|
830 (4) |
313 (8) |
|
|
Unknown/missing
|
0 (0) |
0 (0) |
|
| Decompressive craniectomy |
|
|
<0.001 |
|
No
|
22568 (99) |
3515 (90) |
|
|
Yes
|
281 (1) |
389 (10) |
|
|
Unknown/missing
|
0 (0) |
0 (0) |
|
| External ventricular drainage |
|
|
<0.001 |
|
No
|
22691 (99) |
3898 (100) |
|
|
Yes
|
158 (1) |
6 (0) |
|
|
Unknown/missing
|
0 (0) |
0 (0) |
|
| ICP device insertion |
|
|
<0.001 |
|
No
|
22063 (97) |
3508 (90) |
|
|
Yes
|
786 (3) |
396 (10) |
|
|
Unknown/missing
|
0 (0) |
0 (0) |
|
|
Time (hours) from SH presentation to ICP monitor placement, MD (IQR)
|
3.1 (1.3–7.7) |
8.6 (5.6–17) |
<0.001 |
|
Time (hours) from SH presentation to craniotomy, MD (IQR)
|
2.2 (1.0–6.4) |
4.3 (2.4–11) |
<0.001 |
|
Time (hours) from SH presentation to DC, MD (IQR)
|
2.5 (1.1–12) |
7.6 (4.0–18) |
<0.001 |
|
Time (hours) from SH presentation to EVD insertion, MD (IQR)
|
5.7 (1.8–39) |
4.7 (3.5–361) |
0.83 |
|
Time (hours) from CT-scan to ICP monitor placement, MD (IQR)
|
4.3 (1.6–11) |
7.1 (3.9–16) |
<0.001 |
|
Time (hours) from CT-scan to craniotomy, MD (IQR)
|
3.6 (1.3–8.1) |
5.0 (1.7–14) |
0.007 |
|
Time (hours) from CT-scan to DC, MD (IQR)
|
3.6 (1.2–13) |
6.5 (2.3–17) |
0.0036 |
|
Time (hours) from CT-scan to EVD insertion, MD (IQR)
|
7.1 (1.7–35) |
3.2 (1.6–360) |
0.601 |
|
Length (days) of hospital stay, MD (IQR)
|
0.7 (0.2–5.5) |
1.9 (0.2–7.6) |
<0.001 |
|
Length (days) of hospital stay for admitted patients, MD (IQR)
|
4.0 (1.1–12) |
2.5 (0.3–8.0) |
<0.001 |
|
Length (days) of ICU stay, MD (IQR)
|
3.7 (1.3–12) |
4.0 (1.8–7.3) |
0.122 |
|
Time (days) from injury to death, MD (IQR)
|
3.4 (1.1–9.9) |
4.6 (2.0–9.6) |
0.001 |
|
Time (days) from presentation at study hospital to death, MD (IQR)
|
3.0 (0.9–9.2) |
3.7 (1.7–8.6) |
0.0087 |
|
Time (days) from presentation to study hospital to death or discharge in severe TBI patients, MD (IQR)
|
8.8 (1.8–24) |
8.8 (3.5–18) |
0.902 |
|
Time (days) from presentation to study hospital to discharge in severe TBI patients, MD (IQR)
|
16 (5.5–32) |
13 (7.0–21) |
0.009 |
|
Status at discharge
|
|
|
<0.001 |
| Alive |
21258 (93) |
3491 (89) |
|
| Dead |
1058 (5) |
413 (11) |
|
| Unknown/missing |
533 (2) |
0 (0) |
|
|
Discharge destination
|
|
|
<0.001 |
| Other hospital |
2324 (10) |
424 (11) |
|
| Rehabilitation |
1261 (6) |
13 (0) |
|
| Nursing home |
1208 (5) |
9 (0) |
|
| Home |
15962 (70) |
3035 (78) |
|
| Unknown/missing | 2094 (9) | 423 (11) |
ASDH – acute subdural haematoma, CT – computed tomography, DC – decompressive craniectomy, ED – emergency department, EDH – extradural haematoma, EVD – external ventricular drain, ICP – intracranial pressure, ICU – intensive care unit, IQR – interquartile range, MD – median, SH – study hospital, TBI – traumatic brain injury
*Values presented as n (%) unless specified otherwise.
†Defined as craniotomy for haematoma, DC, ICP device insertion, external ventricular drainage, damage control thoracotomy, damage control laparotomy, extraperitoneal pelvic packing, external fixation limb, interventional radiological procedure or other intervention