Page 20 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 1
AIM AND OUTLINE OF THIS THESIS
This thesis aims to describe and improve the acute treatment decision-making process and research practice in patients with s-TBI.
The following research questions will be answered to address this aim:
1. What is the outcome of patients with s-TBI?
2. What is the in-hospital healthcare consumption and how high are the
in-hospital costs of patients with s-TBI?
3. What challenges are encountered in the acute treatment decision-making
process in patients with s-TBI?
4. What difficulties are encountered in current TBI research practice?
Accordingly, this thesis consists of two parts.
Part I is about the challenges of the treatment decision-making process in patients with (s-)TBI and focusses on three factors considered to be important in this process: patient outcome, in-hospital healthcare consumption, and in-hospital costs. Chapter 2 is a literature review of acute neurosurgical management in patient with very severe TBI (Glasgow Coma Scale 3-5), where several factors related to surgical intervention and patient outcome are investigated. Chapter 3 is a systematic review and quality assessment of available literature on the in-hospital healthcare consumption and in-hospital costs of patients after sustaining s-TBI. Chapter 4 presents functional and patient-reported outcome and in-hospital healthcare consumption and in-hospital costs of a retrospectively investigated regional cohort of patients with a traumatic acute subdural hematoma. Chapter 5 investigates patient outcome, in-hospital healthcare consumption and in-hospital costs of TBI patients that were regionally included in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Chapter 6 summarizes the result of multiple focus group sessions and explores the difficulties of acute decision-making in s-TBI patients.
Part II analyses procedural difficulties in TBI research practice. It focusses on the process of institutional review board approval and the use of informed consent procedures in patients with TBI with an inability to provide informed consent. Chapter 7 describes how the CENTER-TBI study protocol is reviewed and approved by 66 European institutional review boards. Chapter 8 analyses the policy and practice regarding informed consent procedures in patients with an acute inability to provide
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