Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study

Abstract Background Prehospital care for patients with traumatic brain injury (TBI) varies some emergency medical systems recommending direct transport of moderate to severe TBI hospitals specialist neurotrauma (SNCs). The aim this study is assess variation in levels early secondary referral within European SNCs and compare the outcomes directly admitted secondarily transferred patients. Methods Patients (Glasgow Coma Scale < 13) from prospective CENTER-TBI were included study. All participating neuroscience centers. First, adjusted between-country differences analysed using random effects logistic regression where was dependent variable, a intercept country included. Second, effect on survival hospital discharge functional outcome [6 months Glasgow Outcome Extended (GOSE)] estimated ordinal mixed models, respectively. Results A total 1347 moderate/severe 53 18 countries Of these patients, 195 (14.5%) after referral. Secondarily referred presented more often CT abnormality: mass lesion (52% vs. 34%), midline shift (54% 36%) acute subdural hematoma (77% 65%). After adjusting case-mix, there large referral, median OR 1.69 between countries. Early not associated (adjusted 1.07, 95% CI 0.78–1.69), nor at (1.05, 0.58–1.90). Conclusions Across Europe, substantial practice exists proportion that explained by case mix. Within does seem impact stabilisation non-specialised hospital. Future research should identify which truly benefit transportation.