Risk Adjustment In Neurocritical care

Status: Published

What was this study about?

Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. It has been recommended that patients with a severe TBI should be managed within a neuroscience centre. Currently, many (particularly those who do not require surgery) are neither treated in, nor transferred to one. A combination of geography, bed availability, local variation and clinical assessment of prognosis can often determine the location of critical care for adult patients with TBI.

Risk prediction models are tools which can be used to predict the risk of a specific outcome, such as severe disability. They could be used to assist healthcare professionals to make decisions about a patient’s care.  A number of risk prediction models for TBI exist. The aim of the RAIN Study was to consider available risk prediction models for TBI and to use the best model to evaluate the best location to treat adult patients with a TBI. It also considered whether transfer to a neurosciences centre would be more beneficial and cost-effective.

67 UK adult critical care units took part in the study and collected data on 3626 patients with a TBI between July 2009 and March 2011. The patients were followed up six months after their initial TBI.

This study used data from the Case Mix Programme

What did the study find?

The most common causes of TBI were road traffic accidents (33%), falls (47%) and assault (12%). Patients were generally  young (average age 45 years) and the majority (76%) were male.  Information was obtained for 81% of patients at six months. Overall, 61% of patients either did not survive or had severe disability at six months.  

The existing risk prediction models fell below the level required to guide individual patient decision-making, but are still useful in research. The results of the study support current recommendations that all patients with a severe TBI would benefit from transfer to a neurosciences centre, regardless of the need for surgery. We recommend further research to improve risk prediction models. 

Who led the study?

Dr David Harrison, ICNARC

The study was funded by the National Institute for Health Research – Health Technology Assessment Programme (Project: 07/37/29)

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