Abstract Background Valid and relevant estimates of health state preference weights (HSPWs) for Glasgow Outcome Scale (GOS) categories are a key input of economic models evaluating treatments for ...traumatic brain injury (TBI). Objectives To characterize existing HSPW estimates, and model the EuroQol five-dimensional questionnaire (EQ-5D) from the GOS, to inform parameterization of future economic models. Methods A systematic review of HSPWs for GOS categories following TBI was conducted using a highly sensitive search strategy implemented in an extensive range of information sources between 1975 and 2016. A cross-sectional mapping study of GOS health states onto the three-level EQ-5D UK tariff index values was also performed in patients with significant TBI (head region Abbreviated Injury Scale score ≥3) from the Victoria State Trauma Registry. A limited dependent variable mixture model was used to estimate the 12-month EQ-5D UK value set as a function of GOS category, age, and other explanatory variables. Results Six unique HSPWs from five eligible studies were identified. All studies were at high risk of bias with limited applicability. The magnitude of HSPWs differed significantly between studies. Three class mixture models demonstrated excellent goodness of fit to the observed Victoria State Trauma Registry data. GOS category, age at injury, sex, comorbidity, and major extracranial injury all had significant independent effects on mean EQ-5D utility values. Conclusions The few available HSPWs for GOS categories are challenged by potential biases and restricted generalizability. Mixture models are presented to provide HSPWs for GOS categories consistent with the National Institute for Health and Care Excellence reference case.
Management of patients with head injury Mendelow, A David, Prof; Timothy, Jake, FRCS; Steers, James W, FRCS ...
The Lancet (British edition),
08/2008, Letnik:
372, Številka:
9639
Journal Article
Recenzirano
Revised UK guidelines from the National Institute for Health and Clinical Excellence (NICE) for the management of acute head injury address the initial management and triage/ Evidence has also shown ...that even patients who have sustained a minor head injury have difficulty reintegrating into society.5 Thus, management of head injury is an important topic. The principles for the triage of patients with head injuries were set out in the Royal College of Surgeons' report in 2005.11 This report and the Scottish Intercollegiate Guidelines Network6 were largely based on clinical risk factors and the presence of a skull fracture radiograph.15 This approach resulted in about 5% of patients (about 50000 patients per year in the UK) with head injury proceeding to a CT scan.
Abstract Background There is strong evidence that severely injured patients are optimally treated within inclusive trauma networks. One feature of such networks is prehospital triage of the most ...injured patients to designated trauma hospitals. In April, 2012, major trauma services across England were reconfigured into regional trauma networks based around designated major trauma centres (MTCs). This study explored the early effects of the regionalisation of major trauma services in England. Methods The Trauma & Audit Research Network (TARN) identified severely injured patients treated in the 9 months before and after each MTC became fully operational. Outcomes included quality indicators (eg, time to CT scanning for head injured patients) and clinical outcomes (eg, in-hospital mortality). Completeness of the TARN dataset was quantified with Hospital Episode Statistics. Death registrations were used to identify any change in the overall number of traumatic deaths in England. Findings The number of severely injured patients treated in MTCs increased from 7705 to 12 476. All care quality indicators improved: treatment by a consultant (30·4% before MTC vs 54·3 after MTC, p<0·0001), administration of tranexamic acid to bleeding patients (17·0% vs 58·5, p=0·006), and time to CT scanning for head injured patients (49·2 min vs 31·2, p<0·0001). Fewer patients required secondary transfer between hospitals (31·3% vs 25·9, p<0·0001) and a greater proportion were discharged with a Glasgow Outcome Scale of good recovery (52·4% vs 64·5, p<0·0001). There were no differences in either crude or adjusted mortality between the periods for all patients or for those with an Injury Severity Score of more than 15. The overall number of traumatic deaths in England did not change. Interpretation There is early evidence of improved care associated with trauma service regionalisation, including some process measures, enhanced case reporting for national audit, and reduced need for secondary transfer of patients between hospitals. However, in this early post-implementation analysis, significant reductions in patient mortality were not observed. Funding Royal College of Surgeons of England Fulbright Scholarship.
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