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Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study
Author(s): Huijben, Jilske A
Wiegers, Eveline J A
Ercole, Ari
de Keizer, Nicolette F
Maas, Andrew I R
Steyerberg, Ewout W
Citerio, Giuseppe
Wilson, Lindsay
Polinder, Suzanne
Nieboer, Daan
Menon, David
Lingsma, Hester F
van der Jagt, Mathieu
Keywords: Quality indicators
Traumatic brain injuries
Intensive care units
Quality of health care
Issue Date: 2020
Date Deposited: 27-Mar-2020
Citation: Huijben JA, Wiegers EJA, Ercole A, de Keizer NF, Maas AIR, Steyerberg EW, Citerio G, Wilson L, Polinder S, Nieboer D, Menon D, Lingsma HF & van der Jagt M (2020) Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study. Critical Care, 24, Art. No.: 78.
Abstract: Background: The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement. Methods: Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10. Results: A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre. Conclusions: Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators. Trial registration: The core study was registered with, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
DOI Link: 10.1186/s13054-020-2791-0
Rights: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Notes: Additional co-authors listed: the CENTER-TBI investigators and participants for the ICU stratum
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