Trends of clinical outcomes in patients with a Traumatic Brain Injury (TBI) in Canada between 2006 and 2012

•Between 2006 and 2012, some clinical outcomes among traumatic brain injured patients’ improved in Canada.•A decrease in mortality was observed nationally, mostly driven by the province of Ontario.•A decrease in hospital length of stay was observed nationally, mostly driven by the province of Quebec...

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Bibliographic Details
Published in:	Injury Vol. 51; no. 1; pp. 76 - 83
Main Authors:	Sawadogo, D., Moore, L., Tardif, P.A., Farhat, I., Lauzier, F., Turgeon, A.F.
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Ltd 01-01-2020
Subjects:	Canada Clinical outcomes Hospital length of stay Intensive care unit Mortality Province Readmission Reduction Trauma systems Traumatic brain injury Trends SBP Traumatic brain injury Mortality Readmission AIS Clinical outcomes Intensive care unit Province LOS Canada Reduction Trauma systems GCS TBI ICU Hospital length of stay Trends
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Summary:	•Between 2006 and 2012, some clinical outcomes among traumatic brain injured patients’ improved in Canada.•A decrease in mortality was observed nationally, mostly driven by the province of Ontario.•A decrease in hospital length of stay was observed nationally, mostly driven by the province of Quebec.•Alberta was the only province where a reduction of intensive care unit length of stay was observed.•No significant trend was observed regarding readmissions. Traumatic brain injuries (TBI) are the leading cause of death for people aged <40 years. In Canada, the structure of trauma care has evolved independently across provinces during the last decade. However, little is known about the evolution of clinical outcomes. We aimed to compare trends in hospital mortality, unplanned readmission, hospital length of stay (LOS) and intensive care unit (ICU) LOS for TBI between 2006 and 2012 across Canadian provinces. We conducted a retrospective multicentre cohort study based on TBI admissions across Canadian level I and II trauma centres. Data were extracted from the National Trauma Registry linked to hospital discharge databases. All adults with an injury severity score ≥12 were included. Multilevel generalized linear models were used to evaluate trends in clinical outcomes. Between 2006 and 2012, we observed a decrease in mortality in Canada (odd ratio [OR] = 0.95; 95% confidence intervals [CI] = 0.92–0.98) mostly driven by Ontario (OR = 0.95; 95% CI = 0.93–0.98). We observed a significant decrease in hospital length of stay in Canada (hazard ratio [HR]: hazard of being discharged alive from hospital = 1.02; 95% CI = 1.01–1.02) mostly driven by a decrease in Quebec (HR = 1.03; 95% CI = 1.01–1.04). We observed a decrease in ICU Length of stay only in Alberta (HR = 1.05; 95% CI = 1.01–1.09). No trend was observed for hospital readmissions. We observed significant decreases in mortality, hospital and ICU length of stay for TBI in Canada between 2006 and 2012 but only in certain provinces. This study may represent the first step towards a better understanding of the influence of trauma system configuration on the burden of injuries in Canada.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0020-1383 1879-0267
DOI:	10.1016/j.injury.2019.08.023