Page 96 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 4
also seen in TBI, where it lacks and where expensive life-saving surgical treatments can also result in a poor HRQoL. 19,20
Because patient outcome and in-hospital costs of patients with a t-ASDH are of great individual and societal importance, the aim of this study is threefold: (1) assess functional outcome and TBI-specific HRQoL, (2) calculate the in-hospital costs and (3) serve as a basis for future research that focusses on the cost-effectiveness of surgical treatment of patients with t-ASDH.
METHODS AND MATERIALS
Study setting
This retrospective cohort study was conducted at the neurosurgical departments of two collaborating level I trauma centres in The Netherlands (Leiden University Medical Center, Leiden and Haaglanden Medical Center, The Hague). The study reports in-hospital costs and long term HRQoL follow-up data of patients that are part of a cohort partly used in a separate study by the same investigators. 21 The research ethics committees of South-West Holland and Leiden University Medical Center provided ethical approval (study number P12.196).
Patients
All consecutive patients with TBI (2008-2012) treated by the department of neurosurgery were identified by screening the hospital registration system. In addition, the national trauma registry was checked for potential missed inclusions. Inclusion criteria were (1) closed head injury due to a traumatic event (2) direct presentation to the emergency department of a referring or study hospital following trauma (3) a hyperdense, crescent shaped lesion on CT, indicative of an ASDH and (4) age ≥16 years. To pursue a homogenous patient cohort, patients were excluded in case of non-survivable extracranial injuries, a non-traumatic ASDH, when the ASDH was accompanied by concomitant intracranial lesions (i.e. intracerebral hematoma or epidural hematoma) requiring immediate surgical management and when the ASDH was secondary to an earlier procedure or penetrating brain injury. Eligibility for the QOLIBRI questionnaire was assessed based on exclusion criteria: GOS≤3, inability to provide informed consent and inability to understand, cooperate and answer QOLIBRI questions. TBI severity was defined according to the commonly used Glasgow Coma
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