Age-Stratified Treatment Variations in Acute Intracranial Surgery for Traumatic Brain Injury in Europe: A Prospective Observational Study Within CENTER-TBI

High-quality evidence to guide the practice of acute cranial surgery across age groups in traumatic brain injury (TBI) remains sparse. Current surgical guidelines generally do not consider age in their recommendations. The aim of the study is to evaluate acute cranial surgery rates and center treatment differences across age in TBI. Data were extracted from the prospective observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. The CENTER-TBI study included patients with TBI between 2014 and 2017 from 65 level 1 trauma centers across Europe and Israel. Data from all 27,358 patients with TBI enrolled in the CENTER-TBI core study (<i>n</i> = 4509) and registry (<i>n</i> = 22,849) were considered. Eight patients with missing age were excluded, leading to a final analytic sample of 27,350 (core study <i>n</i> = 4504, registry <i>n</i> = 22,846). Variations in probability, defined as case-mix adjusted proportions, of acute surgical treatment of intracranial mass effect (primary decompressive craniectomy or craniotomy), performed within 24 h of initial injury, were expressed using median odds ratios (MORs). Adjusted odds ratios (aORs) were calculated using random-effects linear regression to assess the association between age and the probability of acute cranial surgery for acute subdural hematoma, epidural hematoma, or intracerebral hemorrhage/contusions. MORs and aORs were reported with 95% confidence interval (CI). The odds of acute surgery decreased with older age (aOR = 0.93, 95% CI: 0.92-0.95, per each interquartile range increase of 37 years [y]). Variations in center-specific surgery rates increased with age (15-24 y: MOR = 1.4; 25-44 y: MOR = 1.5; 45-64 y: MOR = 1.6; 65-79 y: MOR = 1.8; ≥80 y: MOR = 3.3), except for patients aged <15 y (MOR = 2.9). Older patients with TBI were less likely to receive acute cranial evacuation surgery, independent from other (comorbidity) factors. Higher age was associated with more surgical treatment variation between centers. Neurosurgery for TBI can be improved by age-personalized treatment algorithms.

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Journal
Journal of Neurotrauma
Published
2025-09-24
DOI
https://doi.org/10.1177/08977151251379454
Primary Topic
Traumatic Brain Injury and Neurovascular Disturbances
Type
article
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article

Age-Stratified Treatment Variations in Acute Intracranial Surgery for Traumatic Brain Injury in Europe: A Prospective Observational Study Within CENTER-TBI

Thomas A. van Essen, Inge A. M. van Erp, Wouter A. Moojen, Alfonso Lagares et al.
Journal of Neurotrauma
Traumatic Brain Injury and Neurovascular Disturbances
article

Age-Stratified Treatment Variations in Acute Intracranial Surgery for Traumatic Brain Injury in Europe: A Prospective Observational Study Within CENTER-TBI

Thomas A. van Essen, Inge A. M. van Erp, Wouter A. Moojen, Alfonso Lagares, Godard C. W. de Ruiter, Wilco C. Peul, Bart P. Depreitere, Ranjit D. Singh, Alexander Younsi, Hugo F. den Boogert, Jeroen T.J.M. van Dijck, John K. Yue, Andrew I.R. Maas
article en

Abstract

High-quality evidence to guide the practice of acute cranial surgery across age groups in traumatic brain injury (TBI) remains sparse. Current surgical guidelines generally do not consider age in their recommendations. The aim of the study is to evaluate acute cranial surgery rates and center treatment differences across age in TBI. Data were extracted from the prospective observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. The CENTER-TBI study included patients with TBI between 2014 and 2017 from 65 level 1 trauma centers across Europe and Israel. Data from all 27,358 patients with TBI enrolled in the CENTER-TBI core study (<i>n</i> = 4509) and registry (<i>n</i> = 22,849) were considered. Eight patients with missing age were excluded, leading to a final analytic sample of 27,350 (core study <i>n</i> = 4504, registry <i>n</i> = 22,846). Variations in probability, defined as case-mix adjusted proportions, of acute surgical treatment of intracranial mass effect (primary decompressive craniectomy or craniotomy), performed within 24 h of initial injury, were expressed using median odds ratios (MORs). Adjusted odds ratios (aORs) were calculated using random-effects linear regression to assess the association between age and the probability of acute cranial surgery for acute subdural hematoma, epidural hematoma, or intracerebral hemorrhage/contusions. MORs and aORs were reported with 95% confidence interval (CI). The odds of acute surgery decreased with older age (aOR = 0.93, 95% CI: 0.92-0.95, per each interquartile range increase of 37 years [y]). Variations in center-specific surgery rates increased with age (15-24 y: MOR = 1.4; 25-44 y: MOR = 1.5; 45-64 y: MOR = 1.6; 65-79 y: MOR = 1.8; ≥80 y: MOR = 3.3), except for patients aged <15 y (MOR = 2.9). Older patients with TBI were less likely to receive acute cranial evacuation surgery, independent from other (comorbidity) factors. Higher age was associated with more surgical treatment variation between centers. Neurosurgery for TBI can be improved by age-personalized treatment algorithms.

Journal of NeurotraumaVol. 43(3-4)
University of Antwerp (BE), University of California, San Francisco (US), Heidelberg University (DE), Leiden University Medical Center (NL), University Hospital Heidelberg (DE), Research Institute Hospital 12 de Octubre (ES), Medisch Centrum Haaglanden (NL), Hospital Universitario 12 De Octubre (ES), Antwerp University Hospital (BE), KU Leuven (BE)
Massachusetts General Hospital, Helsingin Yliopisto, Johns Hopkins University, Auckland University of Technology, New Zealand, Helsingin ja Uudenmaan Sairaanhoitopiiri, Norges Teknisk-Naturvitenskapelige Universitet, Oxford Brookes University, Broad Institute, Universitätsmedizin Göttingen, National Institute for Health and Care Research, University of Cambridge, Imperial College London, University of Oxford, University of Glasgow, Universiteit Leiden, Rijksuniversiteit Groningen, Monash University, Radboud Universiteit, University of Stirling, Erasmus Medisch Centrum, Universität Wien, Hebrew University of Jerusalem, Karolinska Institutet, Odense Universitetshospital, Umeå Universitet, Leids Universitair Medisch Centrum, Universitair Medisch Centrum Groningen, Rigshospitalet, Region Hovedstaden, Universitetet i Oslo, Turun Yliopisto, Université de Liège, Medizinische Universität Wien, Radboud Universitair Medisch Centrum, Humboldt-Universität zu Berlin, Allgemeine Unfallversicherungsanstalt, Klinički Centar Vojvodine, Freie Universität Berlin, Universiteit Antwerpen, Debreceni Egyetem, Pécsi Tudományegyetem, St. Olavs Hospital Universitetssykehuset i Trondheim, Turun Yliopistollinen Keskussairaala, Surgical Reconstruction and Microbiology Research Centre, Centre hospitalier régional universitaire de Lille, Szegedi Tudományegyetem, Kauno Technologijos Universitetas, Center for Stroke Research Berlin, Berlin Institute of Health, Sheffield Teaching Hospitals NHS Foundation Trust, Renji Hospital, University of California, Los Angeles, University of California, San Francisco, Stanley Center for Psychiatric Research, Broad Institute, Manchester Biomedical Research Centre, Medical Research Council, Menzies Centre for Australian Studies, King's College London, University of London, Általános Orvostudományi Kar, Pécsi Tudományegyetem, Universitätsklinikum Hamburg-Eppendorf, Medisinske fakultet, Universitetet i Oslo, Dipartimento di Medicina e Chirurgia, Università degli Studi di Milano-Bicocca
Openalex Percentile: Top 63%
Traumatic Brain Injury and Neurovascular Disturbances
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