Olav Røise

• Bere, Elling Tufte; Christiansen, Solveig Tobie Glestad; Kamaleri, Yusman Bin; Ohm, Eyvind; Madsen, Christian & Røise, Olav [Show all 8 contributors for this article] (2026). Odds of sickness absence and disability pension after bicycle injuries: A Norwegian nationwide register study. Journal of Safety Research. ISSN 0022-4375. 99, p. 137–146. doi: 10.1016/j.jsr.2026.09.012. Full text in Research Archive Show summary

  Introduction: Increased bicycling is a key strategy for health and environmental goals, yet it may increase the number of cycling injuries, which is a risk factor for subsequent work disability. Low socioeconomic status (SES) is a known risk factor for both general traffic injuries and work disability, but less is known about social inequalities in long-term work disability following bicycle-specific accidents. This study assessed the risk of work disability among injured bicyclists and investigated associations with SES and injury severity. Method: We conducted a nationwide population-based case-control study, linking Norwegian Trauma Registry data (2015–2018) with administrative registries on welfare benefits and SES. The sample included 975 injured bicyclists (cases) aged 18–58 and 4,875 matched controls. Work disability, operationalized as receipt of sickness benefits, work assessment allowance, and disability pension, was assessed for four years post-injury. Injury severity was classified using the New Injury Severity Score (NISS). Results: Cases had significantly higher rates of work disability than controls. Four years post-accident, the odds of being on work assessment allowance or disability pension were more than doubled for cases (OR 2.44, 95% CI: 1.82–3.27). The odds increased markedly with injury severity (OR 7.40 for NISS ≥ 16). Bicycle injuries were more common among higher-income individuals (52% in the highest income quartile), in contrast to patterns observed for other road user groups. The relative increase in work disability associated with injury was stronger among high-income individuals (OR 3.32) than among low-income individuals (OR 1.26). Conclusions: Bicycle injuries substantially increased the odds of long-term work disability. Injured cyclists had a high socioeconomic profile, but injury severity was the strongest predictor of long-term work disability. Practical Applications: These findings indicate that assessment of the burden of cycling injuries should incorporate long-term functional and socioeconomic consequences.

• Mjåland, Odd; Hesjevoll, Ingeborg Storesund; Bjørnskau, Torkel; Røise, Olav & Garratt, Andrew (2026). Clinical and patient-reported outcomes for bicycle and micro-mobility accidents: A prospective study with 12-month injury follow-up. Injury. ISSN 0020-1383. doi: 10.1016/j.injury.2026.113705. Full text in Research Archive
• Glette, Malin Knutsen; Røise, Olav & Wiig, Siri (2026). Characteristics of Resilience in the Interface Between Nursing Home Staff, General Practitioners, and Hospitals. In Wiig, Siri; Lyng, Hilda Bø; Guise, Veslemøy; Haraldseid-Driftland, Cecilie & Schibevaag, Lene (Ed.), Translating Resilience into Healthcare Practice : Multilevel Theories and Perspectives. CRC Press. ISSN 9781003489689. p. 136–144. doi: https:/doi.org/0.1201/9781003489689-21. Full text in Research Archive Show summary

  Resilience in healthcare is more relevant than ever. Global health crises, increasing service complexity, resource constraints, shortages of qualified

• Vreeburg, Rick J.G.; Singh, Ranjit D.; Yue, John K.; Dijck, Jeroen T.J.M. van; Boogert, Hugo F. den & Posti, Jussi P. [Show all 262 contributors for this article] (2026). The effectiveness of decompressive craniectomy size in traumatic brain injury; an international, observational, comparative effectiveness study. Brain and Spine. 6. doi: 10.1016/j.bas.2026.106019. Full text in Research Archive Show summary

  Introduction Guidelines recommend large decompressive craniectomies (DC) in traumatic brain injury (TBI), yet the optimal size remains debated. Real-world practice often differs from guideline recommendations and generalizability of prior evidence to a broader TBI population is uncertain. Research question What is the comparative effectiveness of DC size on 12-month functional outcome in TBI? Material and methods We selected participants enrolled in the CENTER-TBI diagnosed with TBI who received a hemicraniectomy. Effect of DC size on functional outcome was evaluated with random-effects logistic regression, associating center case-mix adjusted DC sizes to GOSE. Center preference was quantified with the median odds ratio (MOR). Results Among 4509 patients enrolled in CENTER-TBI, 295 underwent a hemicraniectomy. DC size varied from 37 cm2 to 165cm2 (IQR 96 cm2-123cm2, ellipsoid calculation), with a two-times higher probability of receiving a 27 cm2 larger (IQR increase) DC for a similar patient in one center versus another random center (adjusted MOR for DC size 1·7). Only 4 patients received a DC ≥ 12 × 15 cm (cm) or 15 cm in diameter, while 0 patients received a DC ≤ 6 × 8 cm. Larger DC size was not associated with more favorable 12-month GOSE scores (aOR 0.73 for 27 cm2 increase in DC size, 95%CI 0.47-1.1). Discussion and conclusion DC size varied widely across European centers. Recommended DC sizes were rarely reached, as were very small DC sizes. Larger versus smaller DC was associated with similar outcomes, however heterogeneity in DC indication may have attenuated observable treatment effects. Neurosurgeons may continue to prefer larger over smaller decompressions.

• Nordberg, Synne; Holm, Kjetil Tengesdal; Weber, Clemens & Røise, Olav (2026). The potential impact of changing the Norwegian trauma Registry inclusion criteria for patients not admitted with trauma team activation: Identifying patient groups to be excluded and considering potential risks. European Journal of Trauma and Emergency Surgery. ISSN 1863-9933. 52. doi: 10.1007/s00068-026-03091-x. Full text in Research Archive Show summary

  Purpose One of the inclusion criteria of the Norwegian Trauma Registry (NTR) is a New Injury Severity Score (NISS) > 12 for patients not admitted with trauma team activation (TTA). Based on registry data and clinical experience, patients with NISS of 13 or 14 who are not admitted with TTA often have low-energy falls as the primary injury mechanism. Identifying and registering these patients requires considerable effort. However, it is unknown what effects exclusion of patients with a NISS of 13 or 14 not admitted with TTA will have on the risk and safety of this group of trauma patients. Methods Registry data from a cohort of patients admitted to Norwegian trauma hospitals during 2017–2021 with NISS 13 or 14 who were not met with TTA (group 1) were compared to a cohort of patients with the same NISS scores met with TTA (group 2), and the total registry population, respectively (group 3). Results Group 1 (n = 815) consisted mainly of elderly females (58%), with low-energy falls (73%). The group had a significantly higher proportion of injuries in the lower extremity (61%) and underwent fewer medical interventions than the two comparison groups. Conclusion and implication Increasing the criteria would result in the exclusion of a patient group mainly consisting of elderly women injured with low-energy trauma and hence it is out of the primary scope of a national trauma registry. Uncertainty exists regarding the male patients, who exhibit a higher proportion of injury mechanisms that may have warranted TTA.

• Graziano, Francesca; Guglielmi, Angelo; Consonni, Michela; Ogliari, Giorgia; Younsi, Alexander & Valla, Margherita [Show all 259 contributors for this article] (2026). Paediatric traumatic brain injury: clinical presentation, treatment approaches, management strategies, and outcomes. Insights from the CENTER-TBI study. Journal of Anesthesia, Analgesia and Critical Care. 6. doi: 10.1186/s44158-025-00312-4. Full text in Research Archive Show summary

  Objective: This observational study aims to describe the characteristics and management of paediatric head-injured patients across different paediatric age groups, compared with adults. Design: Secondary analysis of the CENTER-TBI study. Setting: 65 centers in Europe between December 2014 and December 2017. Patients: Patients with traumatic brain injury (TBI) admitted to the hospital were divided into different age groups: paediatrics (pTBI, age ≤ 17 years), adults (18-65 years), and elderly (> 65 years). Paediatrics were further subdivided into three groups: toddlers (from 0 to 4 years), children (from 5 to 12 years), and adolescents (from 13 to 17 years). Interventions: None. Measurements and main results: 3,661 patients were included in the analysis (2,138 admitted to the intensive care unit (ICU) and 1,523 to the ward). Among these, 227 were paediatric (27 toddlers [0-4 years], 65 children [5-12 years], and 135 adolescents [13-17 years]). Most pTBI patients admitted to the ICU presented with mild injuries (Glasgow Coma Scale [GCS] 13-15; 66%), although severe injuries (GCS ≤ 8) were more common in adolescents (23.8%). Susceptibility to neuroworsening and seizures was low in the paediatric group (6% and 3.5%, respectively). Intracranial pressure monitoring was performed in 52 (39.4%) of 132 paediatric ICU patients. Paediatric patients received less intensive therapy targeted to the intracranial pressure (ICP) control particularly in toddlers. Age below 18 years was associated with a lower risk of poor neurological outcomes at six months, particularly in adolescents and children (odds ratio (OR) = 0.31, 95% confidence interval (CI) = 0.15-0.58 p < 0.001 and OR = 0.29, 95% CI = 0.09-0.71, p < 0.001, respectively). In toddlers, the association was not statistically significant (OR = 0.48, 95% CI = 0.07-1.94, p = 0.4). Conclusions: Paediatric TBI differs significantly from non-paediatric cases, with predominantly mild injuries, lower neuroworsening rates, and less intensive management, especially in younger children. Outcomes at six months are generally more favorable in paediatric patients, emphasizing the need for age-specific management strategies in TBI care.

• Zachovajevas, Vilius; Engebretsen, Lars; Moatshe, Gilbert; Zachovajevas, Pavelas & Røise, Olav (2025). Injuries in Mixed Martial Arts After Adoption of the Unified Rules of MMA: A Systematic Review. Orthopaedic Journal of Sports Medicine (OJSM). 13(7). doi: 10.1177/23259671251342578. Full text in Research Archive Show summary

  Background: The existing literature on injuries in mixed martial arts (MMA) is sparse and lacks a summarized review of injuries in the sport after the adoption of the new rule set in 2009. Purpose: To assess the injury characteristics in terms of injury rates and types in MMA after the adoption of the Unified Rules of MMA (URM) by the Association of Boxing Commissions and compare them with preadoption trends. Study Design: Systematic review; Level of evidence, 4. Methods: Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, primary literature in English examining injuries in MMA after URM adoption was scanned in Medline, Embase, and PubMed from the inception of these databases until December 27, 2023. Reports providing relevant information on injury rates and characteristics, with data solely on MMA athletes rather than in a combination of athletes from other combat sports, were reviewed and analyzed. In total, 191 reports were identified after the initial search. Descriptive statistics were employed to summarize injury rates, types, and locations, as well as variations across subgroups. Results: A total of 43 reports were included in the analysis. The reports varied widely in design, injury definitions, and data collection methods. Post-URM competition injury rates ranged from 23.6 to 54.5 injuries per 100 athlete-exposures (AEs), with soft tissue injuries (lacerations/abrasions/contusions) being the most common type of injury (20.7%-56.9% of all injuries). The most common location of injury was the head and neck area (29.5%-75.9% of all injuries). Concussion rates varied from 14.7 to 16.1 per 100 AEs, and heavier fighters experienced more knockouts and technical knockouts. There is some evidence suggesting higher injury rates among professional fighters. Conclusion: The review demonstrated that the most common injuries reported in MMA athletes are soft tissue injuries including lacerations, abrasions, and contusion mainly in the head and neck area. Professional athletes seem to have higher injury rates than amateur athletes, while heavier weight fighters sustain more knockouts and technical knockouts. Current injury rates and types seem to remain similar to those before the adoption of the URM. Analysis of current literature emphasizes a lack of standardized definitions, data on training injuries, and female injuries, which are required to fully evaluate injury characteristics in MMA and ensure the long-term well-being of those participating in the sport.

• Whitehouse, Daniel P.; Wilson, Lindsay; Czeiter, Endre; Buki, Andras; Wang, Kevin K.W. & Steinbüchel, Nicole von [Show all 260 contributors for this article] (2025). Association of Blood-Based Biomarkers and 6-Month Patient-Reported Outcomes in Patients With Mild TBI. Neurology. ISSN 0028-3878. 104(1). doi: 10.1212/wnl.0000000000210040. Full text in Research Archive Show summary

  Background and objectives: There is seemingly contradictory evidence concerning relationships between day-of-injury biomarkers and outcomes after mild traumatic brain injury (mTBI). To address this issue, we examined the association between a panel of biomarkers and multidimensional TBI outcomes. Methods: Participants with mTBI (Glasgow coma scores [GCSs] 13-15) were selected from Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, a European observational study recruiting patients with TBI with indication for brain CT and presentation within 24 hours. Exclusion criteria for this secondary analysis were age younger than 16 years, incomplete biomarker panel, death, or no recorded outcomes. Participants were separated into 2 groups, CT-negative and CT-positive. Multivariable binary logistic regression was used to assess the relation between the log biomarker level (glial fibrillary acidic protein [GFAP], neurofilament light [NfL], neuron-specific enolase [NSE], S100 calcium-binding protein B [S100B], tau, ubiquitin C-terminal hydrolase L1 [UCH-L1]) and dichotomized 6-month outcomes (functional outcomes [GOSE score <8], health-related quality of life [HRQoL; Quality of Life after Brain Injury-Overall Scale (QOLIBRI-OS) score <52, Short-Form 12-Item Survey version 2 Mental Component Summary (SF12v2 MCS) score <40, Short-Form 12-Item Survey version 2 Physical Component Summary (SF12v2 PCS) score <40], persistent postconcussion symptoms [Rivermead Post-Concussion Symptoms Questionnaire score ≥16], anxiety disorder [Generalized Anxiety Disorder-7 (GAD-7) score ≥8], depression [Patient Health Questionnaire-9 (PHQ-9) score ≥10], and post-traumatic stress disorder [PTSD Checklist for DSM-5 (PCL-5) score ≥33]). Results: A total of 1,589 participants (865 CT-negative, 724 CT-positive) were included (77% GCS 15, median age 52 years, 66% male). Higher biomarker levels were associated with a GOSE score <8: CT-negative: S100B (odds ratio [OR] 1.78, 95% CI 1.43-2.23) and UCH-L1 (OR 1.16, 95% CI 1.01-1.33); CT-positive: GFAP (OR 1.22, 95% CI 1.11-1.36), NfL (OR 1.30, 95% CI 1.11-1.52), S100B (OR 1.51, 95% CI 1.23-1.86), tau (OR 1.36, 95% CI 1.17-1.59), and UCH-L1 (OR 1.34, 95% CI 1.17-1.53). In CT-positive participants, positive association was seen between NfL (OR 1.3, 95% CI 1.06-1.60) and UCH-L1 (OR 1.28, 95% CI 1.07-1.54) with QOLIBRI-OS; S100B (OR 1.32, 95% CI 1.02-1.70) with SF12v2 PCS; and NSE (OR 1.52, 95% CI 1.06-2.18) and UCH-L1 (OR 1.21, 95% CI 1.01-1.46) with the GAD-7. However, in CT-negative participants only, negative associations were seen between GFAP and impairment on the QOLIBRI-OS (OR 0.76, 95% CI 0.66-0.88), SF12v2 MCS (OR 0.71, 95% CI 0.61-0.82), SF12v2 PCS (OR 0.79, 95% CI 0.68-0.91), GAD-7 (OR 0.80, 0.68-0.95), PHQ-9 (OR 0.80, 95% CI 0.68-0.93), and PCL-5 (OR 0.80, 95% CI 0.66-0.97). Discussion: Participants with higher biomarker levels had greater odds of impaired functional recovery. However, in CT-negative participants, higher GFAP concentrations were associated with better HRQoL and less impaired mental health. Further exploration is required of the patient phenotypes that may explain the relationships observed in this analysis.

• Mikolić, Ana; Klaveren, David van; Jost, Mathilde; Maas, Andrew IR; Shi, Shuyuan & Silverberg, Noah D [Show all 246 contributors for this article] (2025). Prognostic models for depression and post-traumatic stress disorder symptoms following traumatic brain injury: a CENTER-TBI study. BMJ Mental Health. 28(1). doi: 10.1136/bmjment-2024-301181. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is associated with an increased risk of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). We aimed to identify predictors and develop models for the prediction of depression and PTSD symptoms at 6 months post-TBI. Methods We analysed data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury study. We used linear regression to model the relationship between predictors and depression (Patient Health Questionnaire-9) and PTSD symptoms (PTSD Checklist for Diagnostic and Statistical Manual for Mental Health Disorders Fifth Edition). Predictors were selected based on Akaike’s Information Criterion. Additionally, we fitted logistic models for the endpoints ‘probable MDD’ and ‘probable PTSD’. We also examined the incremental prognostic value of 2–3 weeks of symptoms. Results We included 2163 adults (76% Glasgow Coma Scale=13–15). Depending on the scoring criteria, 7–18% screened positive for probable MDD and about 10% for probable PTSD. For both outcomes, the selected models included psychiatric history, employment status, sex, injury cause, alcohol intoxication and total injury severity; and for depression symptoms also preinjury health and education. The performance of the models was modest (proportion of explained variance=R2 8% and 7% for depression and PTSD, respectively). Symptoms assessed at 2–3 weeks had a large incremental prognostic value (delta R2=0.25, 95% CI 0.24 to 0.26 for depression symptoms; delta R2=0.30, 95% CI 0.29 to 0.31 for PTSD). Conclusion Preinjury characteristics, such as psychiatric history and unemployment, and injury characteristics, such as violent injury cause, can increase the risk of mental health problems after TBI. The identification of patients at risk should be guided by early screening of mental health.

• Nelson, Lindsay D.; Magnus, Brooke E.; Yue, John K.; Balsis, Steve; Patrick, Christopher J. & Temkin, Nancy [Show all 272 contributors for this article] (2025). Beyond mild, moderate, and severe traumatic brain injury: modelling severity from clinical, neuroimaging, and blood-based indicators. EBioMedicine. 121. doi: 10.1016/j.ebiom.2025.106001. Full text in Research Archive Show summary

  Background: The conventional clinical approach to characterising traumatic brain injuries (TBIs) as mild, moderate, or severe using the Glasgow Coma Scale (GCS) total score has well-known limitations, prompting calls for more sophisticated strategies. Methods: We used item response theory (IRT) to develop a new method for quantifying TBI severity using 24 clinical, head computed tomography, and blood-based biomarker variables familiar to clinicians and researchers. IRT uses individuals' response patterns across indicators to estimate relationships between the indicators and a latent continuum of TBI severity. Model parameters were used to assign severity scores in two large cohorts, and associations with traditional GCS categories and 6-month functional outcomes (Glasgow Outcome Scale-Extended [GOSE]) were tested with correlational and logistic regression analyses. Findings: In the prospective Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort (N = 2545), modelling showed the 24 indicators index a common latent continuum of TBI severity. IRT enabled us to identify the relative contribution of these features to estimate an individual's TBI severity. Finally, within both the TRACK-TBI derivation sample and an external validation sample (Collaborative European NeuroTrauma Effectiveness Research in TBI [CENTER-TBI]), TBI severity scores generated using this novel IRT-based method incrementally predicted functional (GOSE) outcome better than classic clinical (mild, moderate, severe) or International Mission for Prognosis and Analysis of Clinical Trials in TBI (IMPACT) classification methods. Interpretation: Our findings directly inform ongoing international efforts to refine and deploy new pragmatic, empirically-supported strategies for characterising TBI, while illustrating a strategy that may be useful to improve staging systems for other diseases.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Soberg, Helene Lundgaard & Røise, Olav [Show all 15 contributors for this article] (2025). Early Injury-Related Predictors of Disability 6 Months After Moderate to Severe Trauma: A Longitudinal Study. Disabilities. 5(3). doi: 10.3390/disabilities5030073. Full text in Research Archive Show summary

  Trauma often causes long-lasting functional impairment, but the extent varies across populations. This study investigated disability six months after moderate to severe injury and identified sociodemographic and early injury-related predictors, including estimated rehabilitation complexity. Further, we assessed the implementation of direct transfer from acute care in the trauma centre to specialised inpatient rehabilitation, bypassing local hospitals. In this prospective study 398 adults, treated from January 2020 to January 2021 at two Norwegian trauma centres, were included. Self-reported disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Ordinal logistic regression was applied to identify predictors of the 6-month disability outcome. At follow-up, 22% reported no disability, 49% mild/moderate and 29% severe. In multivariable analyses, low education, comorbidities, number of injuries and higher estimated rehabilitation complexity at discharge from acute care were significantly associated with greater disability. Only 20% were transferred directly to specialised inpatient rehabilitation, while 17% went via local hospitals. Participants with orthopaedic injuries and women were less likely to be transferred directly. In summary, most participants experienced some disability at 6 months. Indirect pathways to specialised rehabilitation via local hospitals remained common. Understanding predictors of disability and optimising rehabilitation pathways may improve trauma rehabilitation outcomes, highlighting the need for guidelines that identify patients with high rehabilitation needs.

• Finstad, Jeanette; Clausen, Thomas; Røise, Olav; Rosseland, Leiv Arne & Havnes, Ingrid Amalia (2025). Challenges in pain management and opioid prescribing practices following traumatic injury: a focus group study with orthopedic surgeons and general practitioners. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(4), p. 864–879. doi: 10.1080/02813432.2025.2517769. Full text in Research Archive
• Bhattacharyay, Shubhayu; Leeuwen, Florian D. van; Beqiri, Erta; Åkerlund, Cecilia A. I.; Wilson, Lindsay & Steyerberg, Ewout W. [Show all 257 contributors for this article] (2025). TILTomorrow today: dynamic factors predicting changes in intracranial pressure treatment intensity after traumatic brain injury. Scientific Reports. 15(1). doi: 10.1038/s41598-024-83862-x. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn Johannes Bernardus; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2025). Population-based multistate modelling of peritraumatic opioid use among trauma patients from the Norwegian Trauma Registry. British Journal of Anaesthesia. ISSN 0007-0912. 135(2), p. 390–400. doi: 10.1016/j.bja.2025.05.008. Full text in Research Archive
• Cuevas-Østrem, Mathias; Wisborg, Torben; Røise, Olav; Helseth, Eirik & Jeppesen, Elisabeth (2025). Decision-making in interhospital transfer of traumatic brain injury patients: exploring the perspectives of surgeons at general hospitals and neurosurgeons at neurotrauma centres. BMC Health Services Research. 25(1). doi: 10.1186/s12913-024-11968-z. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is a significant public health concern. Advancing age and comorbidities are associated with a reduced probability of being transferred to neurotrauma centres (NTCs) from non-neurosurgical acute care trauma hospitals (ACTHs). However, the extent to which these decisions reflect well-considered treatment-limiting decisions and which influence other factors have on the decision-making process remains unclear. Objective To increase the understanding of adults’ access to NTC care by exploring the decision-making process for interhospital transfer of patients with isolated TBI, elucidating factors influencing these decisions. Methods Fifteen surgeons and neurosurgeons from four hospitals in Norway were recruited through purposive sampling to four semi-structured focus group interviews. Surgeons represented ACTHs and neurosurgeons NTCs, and all participants were responsible for TBI patients' initial care and transfer decisions. Interviews were thematically analysed. Results We identified several factors influencing transfer decisions, captured in six main themes under one overarching theme; ‘The chance of a favourable outcome’. The six main themes reflect surgeons’ and neurosurgeons’ decision-making process, which included clinical and system-level factors: (A) ‘Establish TBI severity: Glasgow Coma Scale score and head CT’, (B) ‘Preinjury health status: comorbidity, functioning, and age’, (C) ‘Distance from ACTH to NTC: distance is time and time is brain’, (D) ‘Uncertainty and insecurity’, (E) ‘Capacity at NTC’, and (F) ‘Next of kin involvement’. Conclusion On-call surgeons and neurosurgeons responsible for making transfer decisions for TBI patients emphasise the importance of patient-centred decisions, including individual patients’ risk factors and overall health status.

• Ringdal, Kjetil G.; Holm, Kjetil Tengesdal & Røise, Olav (2025). The Norwegian national trauma registry: development process and essential data insights. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 33(1). doi: 10.1186/s13049-025-01390-7. Full text in Research Archive Show summary

  Background Understanding trauma epidemiology, patient demographics, injury characteristics, and outcomes is essential for optimising trauma systems. The Norwegian Trauma Registry (NTR) monitors and improves the Norwegian Trauma System, setting care standards and overseeing system development. The registry was officially recognised as a national register in 2013. This study outlines the establishment of the population-based national registry and provides an overview of selected data. Methods Norway’s trauma system includes trauma centres, acute care hospitals, and prehospital services. The registry collects injury details, clinical outcomes, and patient experiences. Local NTR databases that are linked to a central database are maintained at each hospital, and only certified data registrars can enter and validate data. This enables data linkages across hospitals. The NTR includes potentially severely injured patients but also includes undertriaged patients (defined as severely injured patients who are not met by a trauma team activation upon hospital arrival). Descriptive statistics were used to analyse data from trauma patients registered between 2015 and 2023. Patient-Reported Outcome Measures (PROMs) from 2022 were also assessed. Results From 2015 to 2023, 78 275 trauma patients were recorded, with annual patient inclusion rising from 7586 in 2015 to 9759 in 2023. All 38 Norwegian hospitals contributed data in 2023. Median age was 41 years (IQR: 21–62), and 66.5% were men. The highest injury rate was among those aged 15–24 years. Penetrating injuries accounted for 4.6% of cases. Severely injured patients with New Injury Severity Score (NISS) ≥ 16 totalled 16 678 (21.3%), while 10 509 (13.4%) had an Injury Severity Score (ISS) ≥ 16. Polytrauma was identified in 3783 (4.9%) of patients using the Newcastle definition and in 2508 (3.2%) patients using the Berlin definition. In 2023, a trauma team was activated for 8731(89.4%) patients recorded in the registry. PROMs data from 2022 showed that 47.2% (1018/2157) of the patients reported anxiety or depression 12 months post-injury. Among those without physical injuries, 8.0% (11/138) were out of work or education. Of the severely injured patients (NISS ≥ 16) who were employed or in education prior to the injury, 26.4% (83/314) had not returned to work or education after 12 months. Conclusions The Norwegian Trauma Registry has been successfully implemented in all trauma hospitals in Norway, enabling comprehensive data collection to support trauma care improvements and research.

• Seljemo, Camilla; Røise, Olav; Ree, Eline & Wiig, Siri (2025). Supporting Health Care Resilience Through "reflexive Spaces" in Home Care Services: A Multiple Embedded Case Study. Journal of patient safety. ISSN 1549-8417. 21(7), p. 452–459. doi: 10.1097/PTS.0000000000001375. Full text in Research Archive
• Hoås, Einar Frigstad; Majeed, Waleed Mohammed; Røise, Olav & Uleberg, Oddvar (2024). Adherence to national trauma triage criteria in Norway: a cross-sectional study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 32(1). doi: 10.1186/s13049-024-01306-x. Full text in Research Archive Show summary

  Background: Norwegian hospitals employed individual trauma triage criteria until 2015 when nationwide criteria were implemented. There is a lack of empirical evidence regarding adherence to Norwegian national criteria for activation of the trauma team (NTrC) and the decision-making processes regarding trauma team activation (TTA) within Norwegian trauma hospitals. The objectives of this study were to investigate institutional adherence to the NTrC and to investigate similarities and differences in the decision-making process leading to TTA in Norwegian trauma hospitals. Methods: A digital semi-structured questionnaire regarding adherence to criteria, TTA decision-making and criteria documentation was distributed to all Norwegian trauma hospitals (n = 38) in the spring of 2022. Contact details of trauma coordinators and registrars were provided by the Norwegian Trauma Registry secretariat. Follow-up telephone interviews were conducted at the investigator's discretion in cases of non-respondents or need to cla

• Gupta, Deepak; Singh, Ranjit D.; Vreeburg, Rick Jg; Dijck, Jeroen T.J.M. van; Boogert, Hugo den & Sharma, Kaveri [Show all 74 contributors for this article] (2024). Disparities in casemix, acute interventions, discharge destinations and mortality of patients with traumatic brain injury between Europe and India. Journal of Global Health. ISSN 2047-2978. doi: 10.7189/jogh.14.04227. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) is a major global health problem that disproportionally affects low- and middle-income countries. The needs for patients with TBI therefore may differ between levels of national development. We aimed to describe differences in epidemiology and acute care provision of TBI between India and Europe. Methods We used data from two prospective observational registry studies – the Collaborative Indian NeuroTrauma Effectiveness Research in TBI (CINTER-TBI) and the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI), which included TBI patients with an indication for brain CT-scan presenting to 65 centres across Europe and Israel and two trauma centres in India. We performed descriptive analyses of demographic, injury, and treatment characteristics and used random-effects logistic regression with covariate adjustment to examine the likelihood of acute neurosurgical interventions and in-hospital mortality. Results We included 22 849 patients from CENTE

• Samanta, Romit J; Chiollaz, Anne-Cécile; Needham, Edward; Yue, John K; Helmy, Adel & Zanier, Elisa R. [Show all 61 contributors for this article] (2024). Parsimonious immune-response endotypes and global outcome in patients with traumatic brain injury. EBioMedicine. 118. doi: 10.1016/j.ebiom.2024.105310. Full text in Research Archive Show summary

  Background: The inflammatory response in patients with traumatic brain injury (TBI) offers opportunities for stratification and intervention. Previous unselected approaches to immunomodulation in patients with TBI have not improved patient outcomes. Methods: Serum and plasma samples from two prospective, multi-centre observational studies of patients with TBI were used to discover (Collaborative European NeuroTrauma Effectiveness Research [CENTER-TBI], Europe) and validate (Transforming Research and Clinical Knowledge in Traumatic Brain Injury [TRACK-TBI] Pilot, USA) individual variations in the immune response using a multiplex panel of 30 inflammatory mediators. Mediators that were associated with unfavourable outcomes (Glasgow outcome score-extended [GOS-E] ≤ 4) were used for hierarchical clustering to identify patients with similar signatures. Findings: Two clusters were identified in both the discovery and validation cohorts, termed early-inflammatory and pauci-inflammatory. The early-inflammatory phen

• Kals, Mart; Wilson, Lindsay; Levey, Daniel F.; Parodi, Livia; Steyerberg, Ewout W. & Richardson, Sylvia [Show all 79 contributors for this article] (2024). Genetic vulnerability and adverse mental health outcomes following mild traumatic brain injury: a meta-analysis of CENTER-TBI and TRACK-TBI cohorts. EClinicalMedicine. doi: 10.1016/j.eclinm.2024.102956. Full text in Research Archive Show summary

  Background Post-traumatic stress disorder (PTSD) and depression are common after mild traumatic brain injury (mTBI), but their biological drivers are uncertain. We therefore explored whether polygenic risk scores (PRS) derived for PTSD and major depressive disorder (MDD) are associated with the development of cognate TBI-related phenotypes. Methods Meta-analyses were conducted using data from two multicenter, prospective observational cohort studies of patients with mTBI: the CENTER-TBI study (ClinicalTrials.gov ID NCT02210221) in Europe (December 2014–December 2017) and the TRACK-TBI study in the US (March 2014–July 2018). In both cohorts, the most common causes of injury were road traffic accidents and falls. Primary outcomes, specifically probable PTSD and depression, were defined at 6 months post-injury using scores ≥33 on the PTSD Checklist-5 and ≥15 on the Patient Health Questionnaire-9, respectively. We calculated PTSD-PRS and MDD-PRS for patients aged ≥17 years who had a Glasgow Coma Scale score of 13

• Richter, Sophie; Winzeck, Stefan; Correia, Marta M.; Czeiter, Endre; Whitehouse, Daniel & Kornaropoulos, Evgenios N. [Show all 53 contributors for this article] (2024). Predicting recovery in patients with mild traumatic brain injury and a normal CT using serum biomarkers and diffusion tensor imaging (CENTER-TBI): an observational cohort study. EClinicalMedicine. 75. doi: 10.1016/j.eclinm.2024.102751. Full text in Research Archive Show summary

  Background Even patients with normal computed tomography (CT) head imaging may experience persistent symptoms for months to years after mild traumatic brain injury (mTBI). There is currently no good way to predict recovery and triage patients who may benefit from early follow-up and targeted intervention. We aimed to assess if existing prognostic models can be improved by serum biomarkers or diffusion tensor imaging metrics (DTI) from MRI, and if serum biomarkers can identify patients for DTI. Methods We included 1025 patients aged >18 years with a Glasgow Coma Score >12 and normal CT from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study which recruited between December 19,2014 and December 17, 2017 (NCT02210221). Biomarkers (GFAP, NFL, S100B) were obtained at a median of 8.8 h (Q1–Q3 4.2–16.7) and DTI at 13 days (3–19) after injury. DTI metrics were available in 153 patients for 48 white matter tracts (ICBM-DTI-81 atlas). Incomplete recovery at three months was defined as an extended Glasgow Outcome Scale score <8. Existing prognostic models were fitted with and without biomarkers, or with and without DTI, and internally validated using bootstrapping. Findings 385 (38%) patients had incomplete recovery. Adding biomarkers did not improve performance beyond the best existing clinical prognostic model [optimism-corrected AUC 0.69 (95% CI 0.65–0.72) and R2 17% (11–22)]. Adding DTI metrics significantly enhanced all models [best optimism-corrected AUC 0.82 (0.79–0.85) and R2 75% (39–100)]. The top three prognostic tracts were the left posterior thalamic radiation, left superior cerebellar peduncle and right uncinate fasciculus. Serum biomarkers could have avoided 1 in 5 DTI scans, with GFAP <12 h and NFL 12–24 h from injury performing best. Interpretation DTI substantially improved existing prognostic models for functional outcome in patients with mTBI and a normal CT, and biomarkers could help select patients for MRI. If validated, DTI could allow for targeted follow-up and enrichment of clinical trials of early interventions to improve outcome.

• Wilson, Lindsay; Newcombe, Virginia FJ; Whitehouse, Daniel P; Mondello, Stefania; Maas, Andrew I. R. & Menon, David K. [Show all 52 contributors for this article] (2024). Association of early blood-based biomarkers and six-month functional outcomes in conventional severity categories of traumatic brain injury: capturing the continuous spectrum of injury. EBioMedicine. doi: 10.1016/j.ebiom.2024.105298. Full text in Research Archive Show summary

  Background Traumatic brain injury is conventionally categorised as mild, moderate, or severe on the Glasgow Coma Scale (GCS). Recently developed biomarkers can provide more objective and nuanced measures of the extent of brain injury. Methods Exposure–response relationships were investigated in 2479 patients aged ≥16 enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. Neurofilament protein-light (NFL), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) were assayed from serum sampled in the first 24 h; concentrations were divided into quintiles within GCS severity groups. Relationships with the Glasgow Outcome Scale-Extended were examined using modified Poisson regression including age, sex, major extracranial injury, time to sample, and log biomarker concentration as covariates. Findings Within severity groups there were associations between biomarkers and outcomes after adjustment for covariates: GCS 13–15 and negative CT imaging (relative risks [RRs] from 1.28 to 3.72), GCS 13–15 and positive CT (1.21–2.81), GCS 9–12 (1.16–2.02), GCS 3–8 (1.09–1.94). RRs were associated with clinically important differences in expectations of prognosis. In patients with GCS 3 (RRs 1.51–1.80) percentages of unfavourable outcome were 37–51% in the lowest quintiles of biomarker levels and reached 90–94% in the highest quintiles. Similarly, for GCS 15 (RRs 1.83–3.79), the percentages were 2–4% and 19–28% in the lowest and highest biomarker quintiles, respectively. Interpretation Conventional TBI severity classification is inadequate and underestimates heterogeneity of brain injury and associated outcomes. The adoption of circulating biomarkers can add to clinical assessment of injury severity.

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Brunborg, Cathrine & Søberg, Helene L. [Show all 10 contributors for this article] (2024). Return to Work One Year after Moderate to Severe Traumatic Injury in a Working Age Population. Journal of Clinical Medicine. 13(17). doi: 10.3390/jcm13175308. Full text in Research Archive Show summary

  Background/Objectives: Physical trauma may cause long-term disabilities. The importance of place of residence in the return to work after injuries is little researched. The primary aims of this study were to describe return to work or school (RTW) at 6 and 12 months after moderate to severe traumatic injury and to investigate demographic and injury-related predictors for RTW with an initial focus on geographic centrality of residency. The secondary aim was to investigate the association between RTW and functioning. <p><p>Methods: A prospective cohort study conducted at two Norwegian trauma centres. Inclusion criteria: age 18 to 70 years, at least a two-day hospital stay and a New Injury Severity Score > 9. Information about centrality, demographics, injuries, and return to work were collected. Associations between possible predictors and RTW were assessed using binary logistic regression. <p>Results: Of the 223 participants, 68% had returned to work after 6 months and 77% after 12 months. Twelve-month RTW was 89% after thorax/abdomen injuries, 78% after extremity/spine injuries and 73% after head injuries. More central residency was a significant predictor for RTW in univariable but only within the extremity/spine injury subgroup in multivariable analysis. Negative factors were age, having a blue-collar job, number of injuries and rehabilitation complexity. Function 12 months post-injury was associated with RTW in the multivariable model. <p>Conclusions: RTW after one year was high in all major trauma groups. Demographic and injury-related factors were more important predictors of RTW than centrality of residency. Blue-collar workers and patients with multiple injuries and high rehabilitation complexity should be given special attention to support RTW.

• Vyvere, Thijs Vande; Pisicǎ, Dana; Wilms, Guido; Claes, Lene; Dyck, Pieter Van & Snoeckx, Annemiek [Show all 261 contributors for this article] (2024). Imaging Findings in Acute Traumatic Brain Injury: a National Institute of Neurological Disorders and Stroke Common Data Element-Based Pictorial Review and Analysis of Over 4000 Admission Brain Computed Tomography Scans from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 41(19-20), p. 2248–2297. doi: 10.1089/neu.2023.0553. Full text in Research Archive Show summary

  In 2010, the National Institute of Neurological Disorders and Stroke (NINDS) created a set of common data elements (CDEs) to help standardize the assessment and reporting of imaging findings in traumatic brain injury (TBI). However, as opposed to other standardized radiology reporting systems, a visual overview and data to support the proposed standardized lexicon are lacking. We used over 4000 admission computed tomography (CT) scans of patients with TBI from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study to develop an extensive pictorial overview of the NINDS TBI CDEs, with visual examples and background information on individual pathoanatomical lesion types, up to the level of supplemental and emerging information (e.g., location and estimated volumes). We documented the frequency of lesion occurrence, aiming to quantify the relative importance of different CDEs for characterizing TBI, and performed a critical appraisal of our experience with the intent to inform updating of the CDEs. In addition, we investigated the co-occurrence and clustering of lesion types and the distribution of six CT classification systems. The median age of the 4087 patients in our dataset was 50 years (interquartile range, 29-66; range, 0-96), including 238 patients under 18 years old (5.8%). Traumatic subarachnoid hemorrhage (45.3%), skull fractures (37.4%), contusions (31.3%), and acute subdural hematoma (28.9%) were the most frequently occurring CT findings in acute TBI. The ranking of these lesions was the same in patients with mild TBI (baseline Glasgow Coma Scale [GCS] score 13-15) compared with those with moderate-severe TBI (baseline GCS score 3-12), but the frequency of occurrence was up to three times higher in moderate-severe TBI. In most TBI patients with CT abnormalities, there was co-occurrence and clustering of different lesion types, with significant differences between mild and moderate-severe TBI patients. More specifically, lesion patterns were more complex in moderate-severe TBI patients, with more co-existing lesions and more frequent signs of mass effect. These patients also had higher and more heterogeneous CT score distributions, associated with worse predicted outcomes. The critical appraisal of the NINDS CDEs was highly positive, but revealed that full assessment can be time consuming, that some CDEs had very low frequencies, and identified a few redundancies and ambiguity in some definitions. Whilst primarily developed for research, implementation of CDE templates for use in clinical practice is advocated, but this will require development of an abbreviated version. In conclusion, with this study, we provide an educational resource for clinicians and researchers to help assess, characterize, and report the vast and complex spectrum of imaging findings in patients with TBI. Our data provides a comprehensive overview of the contemporary landscape of TBI imaging pathology in Europe, and the findings can serve as empirical evidence for updating the current NINDS radiologic CDEs to version 3.0.

• Seljemo, Camilla; Wiig, Siri; Røise, Olav; Ellis, Louise A.; Braithwaite, Jeffrey & Ree, Eline (2024). How Norwegian homecare managers tackled COVID-19 and displayed resilience-in-action: Multiple perspectives of frontline-staff. Journal of Contingencies and Crisis Management. ISSN 0966-0879. 32(1). doi: 10.1111/1468-5973.12558. Full text in Research Archive Show summary

  A resilient healthcare system is key to responding to sudden crises, such as the coronavirus disease 2019 (COVID-19) pandemic. Homecare services have been an important platform of healthcare delivery during the pandemic, and healthcare staff on the frontlines of homecare have been confronted with major challenges requiring adaptation to sustain high quality healthcare services. Managers' capacities to adapt to disruptions and challenges are important for an adequate response to challenges on the frontlines. To explore healthcare staff's perspectives on managers at different managerial levels (meso-level) handling of the COVID-19 pandemic in Norwegian homecare services. A qualitative multiple case study was designed including four cases. A case was defined as a homecare service within a Norwegian municipality (public organization). Data were collected through 16 interviews with healthcare staff. Interviews were conducted by using a semi-structured interview guide. Healthcare staff reported their managers as proactive, prepared and responded quickly. Present and supportive managers that provided effective and targeted information, and involved staff in decision-making were key to handling the pandemic in Norwegian homecare services. Our results underscore the interaction between healthcare staff and managers at different managerial levels as essential for quickly react, adapt, and resiliently respond to disruptions like the COVID-19 pandemic. Organizations need to have the flexibility to interact across levels and encourage managers to apply strategies for collaboration and staff involvement, especially during a crisis.

• Robba, Chiara; Graziano, Francesca; Picetti, Edoardo; Åkerlund, Cecilia; Addis, Alberto & Pastore, Giuseppe [Show all 72 contributors for this article] (2024). Early systemic insults following traumatic brain injury: association with biomarker profiles, therapy for intracranial hypertension, and neurological outcomes-an analysis of CENTER-TBI data. Intensive Care Medicine. ISSN 0342-4642. doi: 10.1007/s00134-024-07324-8. Full text in Research Archive Show summary

  Purpose: We analysed the impact of early systemic insults (hypoxemia and hypotension, SIs) on brain injury biomarker profiles, acute care requirements during intensive care unit (ICU) stay, and 6-month outcomes in patients with traumatic brain injury (TBI). Methods: From patients recruited to the Collaborative European neurotrauma effectiveness research in TBI (CENTER-TBI) study, we documented the prevalence and risk factors for SIs and analysed their effect on the levels of brain injury biomarkers [S100 calcium-binding protein B (S100B), neuron-specific enolase (NSE), neurofilament light (NfL), glial fibrillary acidic protein (GFAP), ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), and protein Tau], critical care needs, and 6-month outcomes [Glasgow Outcome Scale Extended (GOSE)]. Results: Among 1695 TBI patients, 24.5% had SIs: 16.1% had hypoxemia, 15.2% had hypotension, and 6.8% had both. Biomarkers differed by SI category, with higher S100B, Tau, UCH-L1, NSE and NfL values in patients with hypotension or both SIs. The ratio of neural to glial injury (quantified as UCH-L1/GFAP and Tau/GFAP ratios) was higher in patients with hypotension than in those with no SIs or hypoxia alone. At 6 months, 380 patients died (22%), and 759 (45%) had GOSE ≤ 4. Patients who experienced at least one SI had higher mortality than those who did not (31.8% vs. 19%, p < 0.001). Conclusion: Though less frequent than previously described, SIs in TBI patients are associated with higher release of neuronal than glial injury biomarkers and with increased requirements for ICU therapies aimed at reducing intracranial hypertension. Hypotension or combined SIs are significantly associated with adverse 6-month outcomes. Current criteria for hypotension may lead to higher biomarker levels and more negative outcomes than those for hypoxemia suggesting a need to revisit pressure targets in the prehospital settings.

• Zheng, Jiang; Ouyang, Yufang; Zhang, Ke; Wang, Zhixing; Younsi, Alexander & Alhalabi, Obada [Show all 54 contributors for this article] (2024). Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury. JAMA Network Open. doi: 10.1001/jamanetworkopen.2024.1556. Full text in Research Archive Show summary

  Importance: The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. Objective: To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. Design, setting, and participants: This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. Main outcomes and measures: The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale-Extended [GOSE] score ≤4). Results: A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). Conclusions and relevance: The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

• Ntikas, Michail; Stewart, William; Ietswaart, Magdalena; Hunter, Angus M.; Maas, Andrew I R & Menon, David K [Show all 57 contributors for this article] (2024). Contrasting Characteristics and Outcomes of Sports-Related and Non-Sports-Related Traumatic Brain Injury. JAMA Network Open. 7. doi: 10.1001/jamanetworkopen.2023.53318. Full text in Research Archive Show summary

  Importance: Exposure to traumatic brain injury (TBI) has raised widespread concern over participation in sports, particularly over possible long-term consequences. However, little is known about the outcomes of individuals presenting to hospitals with sports-related TBI. Objective: To compare the characteristics and outcomes of individuals presenting to hospitals with sports-related and non-sports-related TBI. Design, setting, and participants: The CENTER-TBI (Collaborative European NeuroTrauma Effectiveness Research in TBI) observational cohort study was conducted at hospitals in 18 countries. The study enrolled 4509 patients who had TBI and had an indication for computed tomography (CT), of whom 4360 were 16 years or older. Outcomes were assessed at 3 and 6 months, and groups were compared using regression analyses adjusting for clinical and demographic differences. Data were collected between December 9, 2014, and December 17, 2017, and analyzed from August 2022 to March 2023. Exposure: Sports-related and non-sports-related TBI with subgroups selected by severity of injury. Main outcomes and measures: The main outcome was the Glasgow Outcome Scale-Extended (GOSE) at 6 months, with secondary outcomes covering postconcussion symptoms, health-related quality of life, and mental health. Results: A total of 4360 patients were studied, including 256 (6%) with sports-related TBI (mean [SD] age, 38.9 [18.1] years; 161 [63%] male) and 4104 with non-sports-related TBI (mean [SD] age, 51.0 [20.2] years; 2773 [68%] male). Compared with patients with non-sports-related TBI, patients with sports-related TBI were younger, more likely to have tertiary education, more likely to be previously healthy, and less likely to have a major extracranial injury. After adjustment, the groups did not differ in incomplete recovery (GOSE scores <8) at 6 months (odds ratio [OR], 1.27; 95% CI, 0.90-1.78; P = .22 for all patients; OR, 1.20; 95% CI, 0.83-1.73; P = .34 for those with mild TBI; and OR, 1.19; 95% CI, 0.74-1.92; P = .65 for those with mild TBI and negative CT findings). At 6 months, there was incomplete recovery in 103 of 223 patients (46%) with outcomes in the sports-related TBI group, 65 of 168 (39%) in those with mild sports-related TBI, and 30 of 98 (31%) in those with mild sports-related TBI and negative CT findings. In contrast, at 6 months, the sports-related TBI group had lower prevalence of anxiety, depression, posttraumatic stress disorder, and postconcussion symptoms than the non-sports-related group. Conclusions and relevance: In this cohort study of 4360 patients with TBI, functional limitations 6 months after injury were common after sports-related TBI, even mild sports-related TBI. Persisting impairment was evident in the sports-related TBI group despite better recovery compared with non-sports-related TBI on measures of mental health and postconcussion symptoms. These findings caution against taking an overoptimistic view of outcomes after sports-related TBI, even if the initial injury appears mild.

• Deynse, Helena Van; Cools, Wilfried; Deken, Viktor-Jan De; Depreitere, Bart; Hubloue, Ives & Tisseghem, Ellen [Show all 257 contributors for this article] (2024). One-year employment outcome prediction after traumatic brain injury: A CENTER-TBI study. Disability and Health Journal. ISSN 1936-6574. doi: 10.1016/j.dhjo.2024.101716. Full text in Research Archive Show summary

  Background Traumatic brain injury (TBI) can come with long term consequences for functional outcome that can complicate return to work. Objectives This study aims to make accurate patient-specific predictions on one-year return to work after TBI using machine learning algorithms. Within this process, specific research questions were defined: 1 How can we make accurate predictions on employment outcome, and does this require follow-up data beyond hospitalization? 2 Which predictors are required to make accurate predictions? 3 Are predictions accurate enough for use in clinical practice? Methods This study used the core CENTER-TBI observational cohort dataset, collected across 18 European countries between 2014 and 2017. Hospitalized patients with sufficient follow-up data were selected for the current analysis (N = 586). Data regarding hospital stay and follow-up until three months post-injury were used to predict return to work after one year. Three distinct algorithms were used to predict employment outcomes: elastic net logistic regression, random forest and gradient boosting. Finally, a reduced model and corresponding ROC-curve was created. Results Full models without follow-up achieved an area under the curve (AUC) of about 81 %, which increased up to 88 % with follow-up data. A reduced model with five predictors achieved similar results with an AUC of 90 %.

• Vreeburg, Rick J G; Singh, Ranjit D.; Erp, Inge A M van; Korhonen, Tommi K; Yue, John K & Mee, Harry [Show all 81 contributors for this article] (2024). Early versus delayed cranioplasty after decompressive craniectomy in traumatic brain injury: a multicenter observational study within CENTER-TBI and Net-QuRe. Journal of Neurosurgery. ISSN 0022-3085. 141(4), p. 895–907. doi: 10.3171/2024.1.JNS232172. Full text in Research Archive Show summary

  OBJECTIVE The aim of this study was to compare the outcomes of early (≤ 90 days) and delayed (> 90 days) cranioplasty following decompressive craniectomy (DC) in patients with traumatic brain injury (TBI). METHODS The authors analyzed participants enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Neurotraumatology Quality Registry (Net-QuRe) studies who were diagnosed with TBI and underwent DC and subsequent cranioplasty. These prospective, multicenter, observational cohort studies included 5091 patients enrolled from 2014 to 2020. The effect of cranioplasty timing on functional outcome was evaluated with multivariable ordinal regression and with propensity score matching (PSM) in a sensitivity analysis of functional outcome (Glasgow Outcome Scale–Extended [GOSE] score) and quality of life (Quality of Life After Brain Injury [QOLIBRI] instrument) at 12 months following DC. RESULTS Among 173 eligible patients, 73 (42%) underwent early cra

• Pisică, Dana; Volovici, Victor; Yue, John K; Essen, Thomas A. Van; Boogert, Hugo F den & Vyvere, Thijs Vande [Show all 73 contributors for this article] (2024). Clinical and Imaging Characteristics, Care Pathways, and Outcomes of Traumatic Epidural Hematomas: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. Neurosurgery. ISSN 0148-396X. doi: 10.1227/neu.0000000000002982. Full text in Research Archive Show summary

  BACKGROUND AND OBJECTIVES: Guideline recommendations for surgical management of traumatic epidural hematomas (EDHs) do not directly address EDHs that co-occur with other intracranial hematomas; the relative rates of isolated vs nonisolated EDHs and guideline adherence are unknown. We describe characteristics of a contemporary cohort of patients with EDHs and identify factors influencing acute surgery. METHODS: This research was conducted within the longitudinal, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury cohort study which prospectively enrolled patients with traumatic brain injury from 65 hospitals in 18 European countries from 2014 to 2017. All patients with EDH on the first scan were included. We describe clinical, imaging, management, and outcome characteristics and assess associations between site and baseline characteristics and acute EDH surgery, using regression modeling. RESULTS: In 461 patients with EDH, median age was 41 years (IQR 24-56),

• Finstad, Jeanette; Røise, Olav; Clausen, Thomas; Rosseland, Leiv Arne & Havnes, Ingrid Amalia (2024). A qualitative longitudinal study of traumatic orthopaedic injury survivors' experiences with pain and the long-term recovery trajectory. BMJ Open. 14(1). doi: 10.1136/bmjopen-2023-079161. Full text in Research Archive Show summary

  Objectives To explore trauma patients’ experiences of the long-term recovery pathway during 18 months following hospital discharge. Design Longitudinal qualitative study. Setting and participants Thirteen trauma patients with injuries associated with pain that had been interviewed 6 weeks after discharge from Oslo University Hospital in Norway, were followed up with an interview 18 months postdischarge. Method The illness trajectory framework informed the data collection, with semistructured, in-depth interviews that were analysed thematically. Results Compared with the subacute phase 6 weeks postdischarge, several participants reported exacerbated mental and physical health, including increased pain during 18 months following discharge. This, andalternating periods of deteriorated health status during recovery, made the pathway unpredictable. At 18 months post-discharge, participants were coping with experiences of reduced mental and physical health and socioeconomic losses. Three main themes were identified: (1) coping with persistent pain and reduced physical function, (2) experiencing mental distress without access to mental healthcare and (3) unmet needs for follow-up care. Moreover, at 18 months postdischarge, prescribed opioids were found to be easily accessible from GPs. In addition to relieving chronic pain, motivations to use opioids were to induce sleep, reduce withdrawal symptoms and relieve mental distress. Conclusions and implications The patients’ experiences from this study establish knowledge of several challenges in the trauma population’s recovery trajectories, which may imply that subacute health status is a poor predictor of long-term outcomes. Throughout recovery, the participants struggled with physical and mental health needs without being met by the healthcare system. Therefore, it is necessary to provide long-term follow-up of trauma patients’ health status in the specialist health service based on individual needs. Additionally, to prevent long-term opioid use beyond the subacute phase, there is a need to systematically follow-up and reassess motivations and indications for continued use throughout the recovery pathway.

• Moksnes, Håkon Øgreid; Andelic, Nada; Schäfer, Christoph; Anke, Audny Gabriele Wagner; Søberg, Helene L. & Røe, Cecilie [Show all 17 contributors for this article] (2024). Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries. Journal of Rehabilitation Medicine. ISSN 1650-1977. 56, p. 1–10. doi: 10.2340/jrm.v56.40078. Full text in Research Archive Show summary

  Objective: To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs.<p> <p>Design: Multicentre prospective cohort study. <p>Subjects: Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. <p>Methods: Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended–Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6 months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. <p>Results: In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. <p>Conclusion: Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.

• Seljemo, Camilla; Wiig, Siri; Røise, Olav & Ree, Eline (2023). The role of local context for managers’ strategies when adapting to the COVID-19 pandemic in Norwegian homecare services: a multiple case study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09444-1. Full text in Research Archive Show summary

  Background The COVID-19 pandemic had a major impact on healthcare systems around the world, and lack of resources, lack of adequate preparedness and infection control equipment have been highlighted as common challenges. Healthcare managers’ capacity to adapt to the challenges brought by the COVID-19 pandemic is crucial to ensure safe and high-quality care during a crisis. There is a lack of research on how these adaptations are made at different levels of the homecare services system and how the local context influences the managerial strategies applied in response to a healthcare crisis. This study explores the role of local context for managers’ experiences and strategies in homecare services during the COVID-19 pandemic. Methods A qualitative multiple case study in four municipalities with different geographic locations (centralized and decentralized) across Norway. A review of contingency plans was performed, and 21 managers were interviewed individually during the period March to September 2021. All interviews were conducted digitally using a semi-structured interview guide, and data was subjected to inductive thematic analysis. Results The analysis revealed variations in managers’ strategies related to the size and geographical location of the homecare services. The opportunities to apply different strategies varied among the municipalities. To ensure adequate staffing, managers collaborated, reorganized, and reallocated resources within their local health system. New guidelines, routines and infection control measures were developed and implemented in the absence of adequate preparedness plans and modified according to the local context. Supportive and present leadership in addition to collaboration and coordination across national, regional, and local levels were highlighted as key factors in all municipalities. Conclusion Managers who designed new and adaptive strategies to respond to the COVID-19 pandemic were central in ensuring high-quality Norwegian homecare services. To ensure transferability, national guidelines and measures must be context-dependent or -sensitive and must accommodate flexibility at all levels in a local healthcare service system.

• Mikolić, Ana; Steyerberg, Ewout W.; Polinder, Suzanne; Wilson, Lindsay; Zeldovich, Marina & Steinbueche, Nicole von [Show all 258 contributors for this article] (2023). Prognostic Models for Global Functional Outcome and Post-Concussion Symptoms Following Mild Traumatic Brain Injury: A Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Study. Journal of Neurotrauma. ISSN 0897-7151. 40(15-16), p. 1651–1670. doi: 10.1089/neu.2022.0320. Full text in Research Archive Show summary

  After mild traumatic brain injury (mTBI), a substantial proportion of individuals do not fully recover on the Glasgow Outcome Scale Extended (GOSE) or experience persistent post-concussion symptoms (PPCS). We aimed to develop prognostic models for the GOSE and PPCS at 6 months after mTBI and to assess the prognostic value of different categories of predictors (clinical variables; questionnaires; computed tomography [CT]; blood biomarkers). From the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, we included participants aged 16 or older with Glasgow Coma Score (GCS) 13-15. We used ordinal logistic regression to model the relationship between predictors and the GOSE, and linear regression to model the relationship between predictors and the Rivermead Post-concussion Symptoms Questionnaire (RPQ) total score. First, we studied a pre-specified Core model. Next, we extended the Core model with other clinical and sociodemographic variables available at present

• Zeldovich, Marina; Bockhop, Fabian; Covic, Amra; Mueller, Isabelle; Polinder, Suzanne & Mikolic, Ana [Show all 58 contributors for this article] (2023). Factorial validity and comparability of the six translations of the Rivermead Post-Concussion Symptoms Questionnaire translations: results from the CENTER-TBI study. Journal of Patient-Reported Outcomes. 7(90). doi: 10.1186/s41687-023-00632-5. Full text in Research Archive Show summary

  Background Comparison of patient-reported outcomes in multilingual studies requires evidence of the equivalence of translated versions of the questionnaires. The present study examines the factorial validity and comparability of six language versions of the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) administered to individuals following traumatic brain injury (TBI) in the Collaborative European NeuroTrauma Effectiveness Research (CENTER-TBI) study. Methods Six competing RPQ models were estimated using data from Dutch (n = 597), English (n = 223), Finnish (n = 213), Italian (n = 268), Norwegian (n = 263), and Spanish (n = 254) language samples recruited six months after injury. To determine whether the same latent construct was measured by the best-fitting model across languages and TBI severity groups (mild/moderate vs. severe), measurement invariance (MI) was tested using a confirmatory factor analysis framework. Results The results did not indicate a violation of the MI assumption. The six RPQ

• Essen, Thomas Van; Erp, Inge A. M. van; Lingsma, Hester F; Pisica, Dana; Yue, John K & Singh, Ranjit D. [Show all 55 contributors for this article] (2023). Comparative effectiveness of decompressive craniectomy versus craniotomy for traumatic acute subdural hematoma (CENTER-TBI): an observational cohort study. EClinicalMedicine. 9(63). doi: 10.1016/j.eclinm.2023.102161. Full text in Research Archive Show summary

  Background Limited evidence existed on the comparative effectiveness of decompressive craniectomy (DC) versus craniotomy for evacuation of traumatic acute subdural hematoma (ASDH) until the recently published randomised clinical trial RESCUE-ASDH. In this study, that ran concurrently, we aimed to determine current practice patterns and compare outcomes of primary DC versus craniotomy. Methods We conducted an analysis of centre treatment preference within the prospective, multicentre, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (known as CENTER-TBI) and NeuroTraumatology Quality Registry (known as Net-QuRe) studies, which enrolled patients throughout Europe and Israel (2014–2020). We included patients with an ASDH who underwent acute neurosurgical evacuation. Patients with severe pre-existing neurological disorders were excluded. In an instrumental variable analysis, we compared outcomes between centres according to treatment preference, measured by the ca

• Cuevas-Østrem, Mathias; Thorsen, Kjetil; Wisborg, Torben; Røise, Olav; Helseth, Eirik & Jeppesen, Elisabeth (2023). Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31(1). doi: 10.1186/s13049-023-01097-7. Full text in Research Archive Show summary

  Background Systems ensuring continuity of care through the treatment chain improve outcomes for traumatic brain injury (TBI) patients. Non-neurosurgical acute care trauma hospitals are central in providing care continuity in current trauma systems, however, their role in TBI management is understudied. This study aimed to investigate characteristics and care pathways and identify factors associated with interhospital transfer to neurotrauma centers<p> for patients with isolated moderate-to-severe TBI primarily admitted to acute care trauma hospitals. <p>Methods A population-based cohort study from the national Norwegian Trauma Registry (2015–2020) of adult patients (≥16 years) with isolated moderate-to-severe TBI (Abbreviated Injury Scale [AIS] Head≥3, AIS Body<3 and maximum 1 AIS Body=2). Patient characteristics and care pathways were compared across transfer status strata. A generalized additive model was developed using purposeful selection to identify factors associated with transfer and how they affected transfer probability. <p>Results The study included 1735 patients admitted to acute care trauma hospitals, of whom 692 (40%) were transferred to neurotrauma centers. Transferred patients were younger (median 60 vs. 72 years, P<0.001), more severely injured (median New Injury Severity Score [NISS]: 29 vs. 17, P<0.001), and had lower admission Glasgow Coma Scale (GCS) scores (≤13: 55% vs. 27, P<0.001). Increased transfer probability was significantly associated with reduced GCS scores, comorbidity in patients<77 years, and increasing NISSs until the effect was inverted at higher scores. Decreased transfer probability was significantly associated with increasing age and comorbidity, and distance between the acute care trauma hospital and the nearest neurotrauma center, except for extreme NISSs. <p>Conclusions Acute care trauma hospitals managed a substantial burden of isolated moderate-to-severe TBI patients primarily and definitively, highlighting the importance of high-quality neurotrauma care in non-neurosurgical hospitals. The transfer probability declined with increasing age and comorbidity, suggesting that older patients were carefully selected for transfer to specialized care.

• Riemann, Lennart; Mikolic, Ana; Maas, Andrew; Unterberg, Andreas; Younsi, Alexander & Åkerlund, Cecilia [Show all 67 contributors for this article] (2023). Computed Tomography Lesions and Their Association With Global Outcome in Young People With Mild Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 40(11-12), p. 1243–1254. doi: 10.1089/neu.2022.0055. Full text in Research Archive Show summary

  Mild traumatic brain injury (mTBI) can be accompanied by structural damage to the brain. Here, we investigated how the presence of intracranial traumatic computed tomography (CT) pathologies relates to the global functional outcome in young patients one year after mTBI. All patients with mTBI (Glasgow Coma Scale: 13–15) ≤24 years in the multi-center, prospective, observational Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study were included. Patient demographics and CT findings were assessed at admission, and the Glasgow Outcome Scale Extended (GOSE) was evaluated at 12 months follow-up. The association between a “positive CT” (at least one of the following: epidural hematoma, subdural hematoma, traumatic subarachnoid hemorrhage (tSAH), intraventricular hemorrhage, subdural collection mixed density, contusion, traumatic axonal injury) and functional outcome (GOSE) was assessed using multi-variable mixed ordinal and logistic regression models. A total of 462 patients with mTBI and initial brain CT from 46 study centers were included. The median age was 19 (17–22) years, and 322 (70%) were males. CT imaging showed a traumatic intracranial pathology in 171 patients (37%), most commonly tSAH (48%), contusions (40%), and epidural hematomas (37%). Patients with a positive CT scan were less likely to achieve a complete recovery 12 months post-injury. The presence of any CT abnormality was associated with both lower GOSE scores (odds ratio [OR]: 0.39 [0.24–0.63]) and incomplete recovery (GOSE <8; OR: 0.41 [0.25–0.68]), also when adjusted for demographical and clinical baseline factors. The presence of intracranial traumatic CT pathologies was predictive of outcome 12 months after mTBI in young patients, which might help to identify candidates for early follow-up and additional care.

• Woodrow, Rebecca E; Winzeck, Stefan; Luppi, Andrea I; Kelleher-Unger, Isaac R; Spindler, Lennart R B & Wilson, J T Lindsay [Show all 86 contributors for this article] (2023). Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury. Brain. ISSN 0006-8950. 146(8), p. 3484–3499. doi: 10.1093/brain/awad056. Full text in Research Archive Show summary

  Chronic post-concussive symptoms are common after mild traumatic brain injury (mTBI) and are difficult to predict or treat. Thalamic functional integrity is particularly vulnerable in mTBI and may be related to long-term outcomes but requires further investigation. We compared structural MRI and resting state functional MRI in 108 patients with a Glasgow Coma Scale (GCS) of 13–15 and normal CT, and 76 controls. We examined whether acute changes in thalamic functional connectivity were early markers for persistent symptoms and explored neurochemical associations of our findings using PET data. Of the mTBI cohort, 47% showed incomplete recovery 6 months post-injury. Despite the absence of structural changes, we found acute thalamic hyperconnectivity in mTBI, with specific vulnerabilities of individual thalamic nuclei. Acute fMRI markers differentiated those with chronic post-concussive symptoms, with time- and outcome-dependent relationships in a sub-cohort followed longitudinally. Moreover, emotional and cog

• Åkerlund, Cecilia A. I.; Holst, Anders; Bhattacharyay, Shubhayu; Stocchetti, Nino; Steyerberg, Ewout & Smielewski, Peter [Show all 111 contributors for this article] (2023). Clinical descriptors of disease trajectories in patients with traumatic brain injury in the intensive care unit (CENTER-TBI): a multicentre observational cohort study. Lancet Neurology. ISSN 1474-4422. 1, p. 71–80. doi: 10.1016/S1474-4422(23)00358-7. Full text in Research Archive Show summary

  Background Patients with traumatic brain injury are a heterogeneous population, and the most severely injured individuals are often treated in an intensive care unit (ICU). The primary injury at impact, and the harmful secondary events that can occur during the first week of the ICU stay, will affect outcome in this vulnerable group of patients. We aimed to identify clinical variables that might distinguish disease trajectories among patients with traumatic brain injury admitted to the ICU. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) prospective observational cohort study. We included patients aged 18 years or older with traumatic brain injury who were admitted to the ICU at one of the 65 CENTER-TBI participating centres, which range from large academic hospitals to small rural hospitals. For every patient, we obtained pre-injury data and injury features, clinical characteristics on admission, demographics, physiological param

• Schäfer, Christoph; Moksnes, Håkon Øgreid; Rasmussen, Mari Storli; Hellstrøm, Torgeir; Søberg, Helene L. & Røise, Olav [Show all 15 contributors for this article] (2023). Adherence to Guidelines for Acute Rehabilitation in the Norwegian Trauma Plan. Journal of Rehabilitation Medicine. ISSN 1650-1977. 55. doi: 10.2340/jrm.v55.6552. Full text in Research Archive Show summary

  Objective: To evaluate adherence to 3 central operational recommendations for acute rehabilitation in the Norwegian trauma plan.<p> <p>Methods: A prospective multi-centre study of 538 adults with moderate and severe trauma with New Injury Severity Score >9. <p>Results: Adherence to the first recommendation, assessment by a physical medicine and rehabilitation physician within 72 h following admission to the intensive care unit (ICU) at the trauma centre, was documented for 18% of patients. Adherence to the second recommendation, early rehabilitation in the intensive care unit, was documented for 72% of those with severe trauma and ≥2 days ICU stay. Predictors for early rehabilitation were ICU length of stay and spinal cord injury. Adherence to the third recommendation, direct transfer of patients from acute ward to a specialized rehabilitation unit, was documented in 22% of patients, and occurred more often in those with severe trauma (26%), spinal cord injury (54%) and traumatic brain injury (39%). Being employed, having head or spinal chord injury and longer ICU stay were predictors for direct transfer to a specialized rehabilitation unit. <p>Conclusion: Adherence to acute rehabilitation guidelines after trauma is poor. This applies to documented early assessment by a physical medicine and rehabilitation physician, and direct transfer from acute care to rehabilitation after head and extremity injuries. These findings indicate a need for more systematic integration of rehabilitation in the acute treatment phase after trauma.

• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study. Injury Epidemiology. 10. doi: 10.1186/s40621-023-00431-y. Full text in Research Archive Show summary

  Background - Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.<p> <p>Methods - A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).<p> <p>Results - In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.<p> <p>Conclusions - Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

• Naberezhneva, Natalia; Uleberg, Oddvar; Dahlhaug, Marianne; Giil-Jensen, Vigdis; Ringdal, Kjetil G. & Røise, Olav (2023). Excellent agreement of Norwegian trauma registry data compared to corresponding data in electronic patient records. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 31(1). doi: 10.1186/s13049-023-01118-5. Full text in Research Archive Show summary

  Background - The Norwegian Trauma Registry (NTR) is designed to monitor and improve the quality and outcome of trauma care delivered by Norwegian trauma hospitals. Patient care is evaluated through specific quality indicators, which are constructed of variables reported to the registry by certified registrars. Having high-quality data recorded in the registry is essential for the validity, trust and use of data. This study aims to perform a data quality check of a subset of core data elements in the registry by assessing agreement between data in the NTR and corresponding data in electronic patient records (EPRs). Methods - We validated 49 of the 118 variables registered in the NTR by comparing those with the corresponding ones in electronic patient records for 180 patients with a trauma diagnosis admitted in 2019 at eight public hospitals. Agreement was quantified by calculating observed agreement, Cohen’s Kappa and Gwet’s first agreement coefficient (AC1) with 95% confidence intervals (CIs) for 27 nominal variables, quadratic weighted Cohen’s Kappa and Gwet’s second agreement coefficient (AC2) for five ordinal variables. For nine continuous, one date and seven time variables, we calculated intraclass correlation coefficient (ICC). Results - Almost perfect agreement (AC1 /AC2/ ICC > 0.80) was observed for all examined variables. Nominal and ordinal variables showed Gwet’s agreement coefficients ranging from 0.85 (95% CI: 0.79–0.91) to 1.00 (95% CI: 1.00–1.00). For continuous and time variables there were detected high values of intraclass correlation coefficients (ICC) between 0.88 (95% CI: 0.83–0.91) and 1.00 (CI 95%: 1.00–1.00). While missing values in both the NTR and EPRs were in general negligeable, we found a substantial amount of missing registrations for a continuous “Base excess” in the NTR. For some of the time variables missing values both in the NTR and EPRs were high. Conclusion - All tested variables in the Norwegian Trauma Registry displayed excellent agreement with the corresponding variables in electronic patient records. Variables in the registry that showed missing data need further examination.

• Moksnes, Håkon Øgreid; Schäfer, Christoph; Rasmussen, Mari Storli; Søberg, Helene L.; Røise, Olav & Anke, Audny Gabriele Wagner [Show all 15 contributors for this article] (2023). Functional Outcomes at 6 and 12 Months Post-Injury in a Trauma Centre Population with Moderate-to-Severe Traumatic Injuries. Journal of Clinical Medicine. 12(16). doi: 10.3390/jcm12165300. Full text in Research Archive Show summary

  This study aims to evaluate the global functional outcomes after moderate-to-severe traumatic injury at 6 and 12 months and to examine the sociodemographic and injury-related factors that predict these outcomes. A prospective cohort study was conducted in which trauma patients of all ages with a New Injury Severity Score > 9 who were discharged alive from two regional trauma centres in Norway over a one-year period (2020) were included. The Glasgow Outcome Scale Extended (GOSE) score was used to analyse the functional outcomes. Regression analyses were performed to investigate the predictors of the GOSE score. Follow-up assessments were obtained from approximately 85% of the 601 included patients at both time points. The mean (SD) GOSE score was 6.1 (1.6) at 6 months and 6.4 (1.6) at 12 months, which corresponds to an upper-moderate disability. One-half of the patients had a persistent disability at 12 months post-injury. The statistically significant predictors of a low GOSE score at both time points were more pre-injury comorbidity, a higher number of injuries, and higher estimated rehabilitation needs, whereas a thorax injury with an Abbreviated Injury Scale ≥ 3 predicted higher GOSE scores. A high Glasgow Coma Scale score at admission predicted a higher GOSE score at 6 months. This study strengthens the evidence base for the functional outcomes and predictors in this population.

• Cuevas-Østrem, Mathias; Wisborg, Torben; Røise, Olav & Jeppesen, Elisabeth (2022). Differences in time-critical interventions and radiological examinations between adult and older trauma patients: A national register-based study. Journal of Trauma and Acute Care Surgery. ISSN 2163-0755. 93(4), p. 503–512. doi: 10.1097/TA.0000000000003570. Full text in Research Archive Show summary

  BACKGROUND<p> <p>Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations. <p>METHODS <p>Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests. <p>RESULTS <p>There were 9543 patients included, of which 28% (n = 2711) were 65 years or older. Older patients, irrespective of injury severity, were less likely attended by a prehospital doctor/paramedic team (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.57–0.71), conveyed by air ambulance (OR, 0.65; 95% CI, 0.58–0.73), and transported directly to a trauma center (OR, 0.86; 95% CI, 0.79–0.94). Time-critical intervention and primary survey radiological examination rates only differed between age groups among patients with New Injury Severity Score of 25 or greater, showing lower rates for older adults (advanced airway management: OR, 0.60; 95% CI, 0.47–0.76; chest decompression: OR, 0.46; 95% CI, 0.25–0.85; x-ray chest: OR, 0.54; 95% CI, 0.39–0.75; x-ray pelvis: OR, 0.69; 95% CI, 0.57–0.84). However, for the patients attended by a doctor/paramedic team, there were no management differences between age groups. <p>CONCLUSION <p>Older trauma patients were less likely to receive advanced prehospital care compared with younger adults. Older patients with very severe injuries received fewer time-critical interventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities.

• Finstad, Jeanette; Clausen, Thomas; Rosseland, Leiv Arne; Røise, Olav & Havnes, Ingrid Amalia (2022). Patient experiences after physical trauma: The negative effect of the COVID-19 pandemic on recovery. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19:12258(19), p. 1–9. doi: 10.3390/ijerph191912258. Full text in Research Archive Show summary

  The coronavirus disease 2019 (COVID-19) pandemic generated a crisis within the healthcare system, during which acute, COVID-19-related health needs were prioritized over less urgent needs, including vulnerable subgroups. This study explored experiences of recovery among survivors of physical injuries associated with severe pain during the COVID-19 pandemic in Norway. In-depth interviews were conducted among 13 participants. Findings generated by a thematic analysis revealed that the pandemic, including the contagion control measures and interrupted healthcare, were of negative consequence for the participants’ recovery experiences and mental and physical health. Despite experiencing severe pain and perceived needs for support, the participants experienced being deprioritized by the healthcare system. They experienced a reduced capacity to cope with pandemic-related stress and to perform everyday tasks, which they perceived as generating an additional burden for their loved ones. Alcohol was reported to be used in an effort to relieve the associated mental distress. As suggested by this study, injury survivors constitute a vulnerable subgroup for whom the continuity of rehabilitation services during a national crisis, as well as the integration of mental health support, can be essential for mitigating the negative impact of the crisis on recovery and for promoting optimal long-term health outcomes. Keywords: COVID-19; pandemic; physical trauma; recovery; rehabilitation; mental health; substance use; qualitative research

• Bockhop, Fabian; Zeldovich, Marina; Cunitz, Katrin; Praag, Dominique Van; Vlegel, Marjolein van der & Beissbarth, Tim [Show all 258 contributors for this article] (2022). Measurement invariance of six language versions of the post-traumatic stress disorder checklist for DSM-5 in civilians after traumatic brain injury. Scientific Reports. 12(1), p. 1–15. doi: 10.1038/s41598-022-20170-2. Full text in Research Archive Show summary

  Traumatic brain injury (TBI) is frequently associated with neuropsychiatric impairments such as symptoms of post-traumatic stress disorder (PTSD), which can be screened using self-report instruments such as the Post-Traumatic Stress Disorder Checklist for DSM-5 (PCL-5). The current study aims to inspect the factorial validity and cross-linguistic equivalence of the PCL-5 in individuals after TBI with differential severity. Data for six language groups (n ≥ 200; Dutch, English, Finnish, Italian, Norwegian, Spanish) were extracted from the CENTER-TBI study database. Factorial validity of PTSD was evaluated using confirmatory factor analyses (CFA), and compared between four concurrent structural models. A multi-group CFA approach was utilized to investigate the measurement invariance (MI) of the PCL-5 across languages. All structural models showed satisfactory goodness-of-fit with small between-model variation. The original DSM-5 model for PTSD provided solid evidence of MI across the language groups. The current study underlines the validity of the clinical DSM-5 conceptualization of PTSD and demonstrates the comparability of PCL-5 symptom scores between language versions in individuals after TBI. Future studies should apply MI methods to other sociodemographic (e.g., age, gender) and injury-related (e.g., TBI severity) characteristics to improve the monitoring and clinical care of individuals suffering from PTSD symptoms after TBI.

• Deilkås, Ellen C Tveter; Rosta, Judith; Baathe, Fredrik; Søfteland, Eirik; Lexberg, Åse & Røise, Olav [Show all 7 contributors for this article] (2022). Physician participation in quality improvement work- interest and opportunity: a cross-sectional survey. BMC Primary Care. 23(1), p. 1–9. doi: 10.1186/s12875-022-01878-6. Full text in Research Archive Show summary

  Background: Lack of physician involvement in quality improvement threatens the success and sustainability of quality improvement measures. It is therefore important to assess physicians´ interests and opportunities to be involved in quality improvement and their experiences of such participation, both in hospital and general practice. Methods: A cross-sectional postal survey was conducted on a representative sample of physicians in different job positions in Norway in 2019. Results: The response rate was 72.6% (1513 of 2085). A large proportion (85.7%) of the physicians wanted to participate in quality improvement, and 68.6% had actively done so in the last year. Physicians’ interest in quality improvement and their active participation was significantly related to the designated time for quality improvement in their work-hour schedule (p < 0.001). Only 16.7% reported time designated for quality improvement in their own work hours. When time was designated, 86.6% of the physicians reported participation in quality improvement, compared to 63.7% when time was not specially designated. Conclusions: This study shows that physicians want to participate in quality improvement, but only a few have designated time to allow continuous involvement. Physicians with designated time participate significantly more. Future quality programs should involve physicians more actively by explicitly designating their time to participate in quality improvement work. We need further studies to explore why managers do not facilitate physicians´ participation in quality improvement.

• Eiding, Helge; Røise, Olav & Kongsgaard, Ulf (2022). Potentially Severe Incidents During Interhospital Transport of Critically Ill Patients, Frequently Occurring But Rarely Reported: A Prospective Study. Journal of patient safety. ISSN 1549-8417. 18(1), p. E315–E319. doi: 10.1097/PTS.0000000000000769. Full text in Research Archive Show summary

  Objectives The out-of-hospital environment can pose significant challenges to the quality and safety of interhospital transport of critically ill patients. Because we lack knowledge of the occurrence of incidents, their potential consequences, and whether they are actually reported, this study was initiated. Methods Two different services in Norway were asked to self-report incidents after every interhospital transport of critically ill patients. Sampling lasted for 12 and 8 months, respectively. An expert group evaluated each incident for severity and demand for reporting into the hospital’s electronic incident reporting system. One year later, the hospital’s reporting system was scrutinized to determine the number of incidents actually reported. Results A total of 455 transports of critically ill patients were performed, resulting in 294 unique incidents reported: medical (15%), technical (25%), missing equipment (17%), and personal failures and communication difficulties (42%). Only 3 (1%) of the 294 unique incidents were actually reported in the hospital’s electronic incident reporting system. The experts were inconsistent in which incidents should have been reported and to what degree checklists, standard operating procedures, simulation, and training could have prevented the incidents. Conclusions This study of interhospital transports of critically ill patients reveals a very high number of incidents. Despite this fact, these incidents are severely underreported in the hospital’s electronic incident reporting system. This suggests that learning is lost and errors with predominant probability are repeated. These results emphasize the existing challenges in regard to the quality and safety of interhospital transport of critically ill patients.

• Wilson, Lindsay; Horton, Lindsay; Polinder, Suzanne; Newcombe, Virginia F.J.; Steinbuechel, Nicole v. & Maas, Andrew I. R. [Show all 50 contributors for this article] (2022). Tailoring Multi-Dimensional Outcomes to Level of Functional Recovery after Traumatic Brain Injury. Journal of Neurotrauma. ISSN 0897-7151. 39(19-20), p. 1363–1381. doi: 10.1089/neu.2022.0013. Full text in Research Archive Show summary

  There is increasing emphasis on assessing multi-dimensional outcomes in traumatic brain injury (TBI), but achieving this aim is hampered by a plethora of overlapping assessment tools. There is a clear need for advice on the choice of outcomes and we examined level of functional recovery as a framework to guide selection of assessments. In this cohort study we analysed cross-sectional data from 2604 patients enrolled in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) project. Patients were followed up 6 months after injury and assessed on the Glasgow Outcome Scale-Extended (GOSE), cognitive tests, and patient-reported outcomes. We describe assessment completeness and prevalence of impairment. Relationships between outcomes were visualized using UpSet plots and hierarchical cluster analysis. GOSE categories varied markedly for both completion rates, 34–91% for patient-reported outcomes and 9–81% for cognitive tests, and prevalence of impairment, 3–82% for patient-reported outcomes and 9–59% for cognitive tests. In complete case samples, the GOSE identified impairment in 59–61%, whereas the most impaired patient-reported outcome was the Short Form-12 version 2 (SF-12v2) Physical Component Summary (28% overall), and the most impaired cognitive test was Trail Making Test (TMT) Part A (19% overall). The findings show that degree of disability is a key context of use for cognitive tests and patient-reported outcomes. Level of functional recovery provides a guide to the feasibility of different types of assessment and the likelihood of impairment, and can help tailor suitable assessment approaches in clinical practice and research studies.

• Praag, Dominique L.G. Van; Wouters, Kristien; Eede, Filip Van Den; Wilson, Lindsay; Maas, Andrew I.R. & Åkerlund, Cecilia [Show all 250 contributors for this article] (2022). Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury. Brain and Spine. 2. doi: 10.1016/j.bas.2021.100854. Full text in Research Archive
• Thomas, Ilias; Dickens, Alex M.; Posti, Jussi P.; Czeiter, Endre; Duberg, Daniel & Sinioja, Tim [Show all 255 contributors for this article] (2022). Serum metabolome associated with severity of acute traumatic brain injury. Nature Communications. 13(1), p. 1–15. doi: 10.1038/s41467-022-30227-5. Full text in Research Archive Show summary

  Complex metabolic disruption is a crucial aspect of the pathophysiology of traumatic brain injury (TBI). Associations between this and systemic metabolism and their potential prognostic value are poorly understood. Here, we aimed to describe the serum metabolome (including lipidome) associated with acute TBI within 24 h post-injury, and its relationship to severity of injury and patient outcome. We performed a comprehensive metabolomics study in a cohort of 716 patients with TBI and non-TBI reference patients (orthopedic, internal medicine, and other neurological patients) from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We identified panels of metabolites specifically associated with TBI severity and patient outcomes. Choline phospholipids (lysophosphatidylcholines, ether phosphatidylcholines and sphingomyelins) were inversely associated with TBI severity and were among the strongest predictors of TBI patient outcomes, which was further confirmed in a separate validation dataset of 558 patients. The observed metabolic patterns may reflect different pathophysiological mechanisms, including protective changes of systemic lipid metabolism aiming to maintain lipid homeostasis in the brain.

• Vlegel, Marjolein van der; Mikolić, Ana; Hee, Quentin Lee; Kaplan, Z.L. Rana; Helmrich, Isabel R.A. Retel & Veen, Ernest van [Show all 255 contributors for this article] (2022). Health care utilization and outcomes in older adults after Traumatic Brain Injury: A CENTER-TBI study. Injury. ISSN 0020-1383. 53(8), p. 2774–2782. doi: 10.1016/j.injury.2022.05.009. Full text in Research Archive Show summary

  Introduction The incidence of Traumatic Brain Injury (TBI) is increasingly common in older adults aged ≥65 years, forming a growing public health problem. However, older adults are underrepresented in TBI research. Therefore, we aimed to provide an overview of health-care utilization, and of six-month outcomes after TBI and their determinants in older adults who sustained a TBI. Methods We used data from the prospective multi-center Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. In-hospital and post-hospital health care utilization and outcomes were described for patients aged ≥65 years. Ordinal and linear regression analyses were performed to identify determinants of the Glasgow Outcome Scale Extended (GOSE), health-related quality of life (HRQoL), and mental health symptoms six-months post-injury. Results Of 1254 older patients, 45% were admitted to an ICU with a mean length of stay of 9 days. Nearly 30% of the patients received inpatient rehabilitation. In total, 554/1254 older patients completed the six-month follow-up questionnaires. The mortality rate was 9% after mild and 60% after moderate/severe TBI, and full recovery based on GOSE was reported for 44% of patients after mild and 6% after moderate/severe TBI. Higher age and increased injury severity were primarily associated with functional impairment, while pre-injury systemic disease, psychiatric conditions and lower educational level were associated with functional impairment, lower generic and disease-specific HRQoL and mental health symptoms. Conclusion The rate of impairment and disability following TBI in older adults is substantial, and poorer outcomes across domains are associated with worse preinjury health. Nonetheless, a considerable number of patients fully or partially returns to their preinjury functioning. There should not be pessimism about outcomes in older adults who survive.

• Howe, Emilie; Zeldovich, Marina; Andelic, Nada; Steinbuechel, Nicole von; Fure, Silje Christine Reistad & Borgen, Ida Maria Henriksen [Show all 51 contributors for this article] (2022). Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study. BMC Health Services Research. 22(1), p. 1–16. doi: 10.1186/s12913-022-08908-0. Full text in Research Archive Show summary

  Background Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall

• Dara, Kevin; Bere, Tone Tufte; Hellund, Johan Castberg; Flugsrud, Gunnar B & Røise, Olav (2022). Long-term results after isolated iliac wing fractures. Injury. ISSN 0020-1383. 53(11), p. 3795–3799. doi: 10.1016/j.injury.2022.08.033. Full text in Research Archive Show summary

  Introduction Isolated iliac wing fracture is a rare pelvic fracture that is considered benign in the literature. As there is a complete lack of information on function and quality of life in patients with this injury, the primary aim of this study was to evaluate the long-term functional results, and secondly to evaluate the patients’ clinical function and fracture healing. Patients and Methods All patients treated in Oslo University Hospital, Ullevaal (OUH-U), the Norwegian National Pelvic Service, in the time period 2006–2016 were included. Nine of 13 eligible patients (69%) were evaluated by the Patient Reported Outcome Measures (PROM); EQ-5D-3L and Majeed Score. For the secondary outcomes, the patients were clinically examined for Range of Motion (ROM) in the hips, pain, muscular function and nerve deficiencies. Finally, the patients underwent X-rays (AP-view and iliac and obturator oblique views). Results All patients were injured in high-energy trauma with severe associated injuries. Five patients were operated and four received conservative treatment. At the time of follow-up (median seven years after injury), the mean EQ-5D VAS was 84, and the mean Majeed score was 87. Two out of nine reported moderate level of pain, three reported mild pain, and the rest reported no pain. Six patients were still working, two were retired, and the last one was receiving disability benefit of other reasons than the iliac fracture. One patient had difference in range of external rotation of >10° between the hips, while the rest had no differences in ROM. The follow-up X-rays showed healed fractures in all the patients. Conclusion Patients with isolated iliac wing fractures seem to have a good general state of health, scoring high on the PROMs, with minor and insignificant clinical sequela. This original finding is in accordance with the general assumption amongst pelvic surgeons that the injury is a benign one.

• Maas, Andrew I. R.; Menon, David K.; Manley, Geoffrey; Abrams, Mathew; Åkerlund, Cecilia & Andelic, Nada [Show all 50 contributors for this article] (2022). Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurology. ISSN 1474-4422. 21(11), p. 1004–1060. doi: 10.1016/S1474-4422(22)00309-X. Full text in Research Archive
• Rezoagli, Emanuele; Petrosino, Matteo; Rebora, Paola; Menon, David K.; Mondello, Stefania & Cooper, D. James [Show all 50 contributors for this article] (2022). High arterial oxygen levels and supplemental oxygen administration in traumatic brain injury: insights from CENTER-TBI and OzENTER-TBI. Intensive Care Medicine. ISSN 0342-4642. 48, p. 1709–1725. doi: 10.1007/s00134-022-06884-x. Full text in Research Archive Show summary

  Purpose The effect of high arterial oxygen levels and supplemental oxygen administration on outcomes in traumatic brain injury (TBI) is debated, and data from large cohorts of TBI patients are limited. We investigated whether exposure to high blood oxygen levels and high oxygen supplementation is independently associated with outcomes in TBI patients admitted to the intensive care unit (ICU) and undergoing mechanical ventilation. Methods This is a secondary analysis of two multicenter, prospective, observational, cohort studies performed in Europe and Australia. In TBI patients admitted to ICU, we describe the arterial partial pressure of oxygen (PaO2) and the oxygen inspired fraction (FiO2). We explored the association between high PaO2 and FiO2 levels within the first week with clinical outcomes. Furthermore, in the CENTER-TBI cohort, we investigate whether PaO2 and FiO2 levels may have differential relationships with outcome in the presence of varying levels of brain injury severity (as quantified by levels of glial fibrillary acidic protein (GFAP) in blood samples obtained within 24 h of injury). Results The analysis included 1084 patients (11,577 measurements) in the CENTER-TBI cohort, of whom 55% had an unfavorable outcome, and 26% died at a 6-month follow-up. Median PaO2 ranged from 93 to 166 mmHg. Exposure to higher PaO2 and FiO2 in the first seven days after ICU admission was independently associated with a higher mortality rate. A trend of a higher mortality rate was partially confirmed in the OzENTER-TBI cohort (n = 159). GFAP was independently associated with mortality and functional neurologic outcome at follow-up, but it did not modulate the outcome impact of high PaO2 and FiO2 levels, which remained independently associated with 6-month mortality. Conclusions In two large prospective multicenter cohorts of critically ill patients with TBI, levels of PaO2 and FiO2 varied widely across centers during the first seven days after ICU admission. Exposure to high arterial blood oxygen or high supplemental oxygen was independently associated with 6-month mortality in the CENTER-TBI cohort, and the severity of brain injury did not modulate this relationship. Due to the limited sample size, the findings were not wholly validated in the external OzENTER-TBI cohort. We cannot exclude the possibility that the worse outcomes associated with higher PaO2 were due to use of higher FiO2 in patients with more severe injury or physiological compromise. Further, these findings may not apply to patients in whom FiO2 and PaO2 are titrated to brain tissue oxygen monitoring (PbtO2) levels. However, at minimum, these findings support the need for caution with oxygen therapy in TBI, particularly since titration of supplemental oxygen is immediately applicable at the bedside.

• Essen, Thomas Van; Lingsma, Hester F; Pisică, Dana; Singh, Ranjit D.; Volovici, Victor & Boogert, Hugo F den [Show all 50 contributors for this article] (2022). Surgery versus conservative treatment for traumatic acute subdural haematoma: a prospective, multicentre, observational, comparative effectiveness study. Lancet Neurology. ISSN 1474-4422. 21(7), p. 620–631. doi: 10.1016/s1474-4422(22)00166-1. Full text in Research Archive Show summary

  Background Despite being well established, acute surgery in traumatic acute subdural haematoma is based on low-grade evidence. We aimed to compare the effectiveness of a strategy preferring acute surgical evacuation with one preferring initial conservative treatment in acute subdural haematoma. Methods We did a prospective, observational, comparative effectiveness study using data from participants enrolled in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) cohort. We included patients with no pre-existing severe neurological disorders who presented with acute subdural haematoma within 24 h of traumatic brain injury. Using an instrumental variable analysis, we compared outcomes between centres according to treatment preference for acute subdural haematoma (acute surgical evacuation or initial conservative treatment), measured by the case-mix-adjusted percentage of acute surgery per centre. The primary endpoint was functional outcome at 6 months as rated with the Glasgow Outcome Scale Extended, which was estimated with ordinal regression as a common odds ratio (OR) and adjusted for prespecified confounders. Variation in centre preference was quantified with the median OR (MOR). CENTER-TBI is registered with ClinicalTrials.gov, number NCT02210221, and the Resource Identification Portal (Research Resource Identifier SCR_015582). Findings Between Dec 19, 2014 and Dec 17, 2017, 4559 patients with traumatic brain injury were enrolled in CENTER-TBI, of whom 1407 (31%) presented with acute subdural haematoma and were included in our study. Acute surgical evacuation was done in 336 (24%) patients, by craniotomy in 245 (73%) of those patients and by decompressive craniectomy in 91 (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment (n=982) occurred in 107 (11%) patients. The percentage of patients who underwent acute surgery ranged from 5·6% to 51·5% (IQR 12·3–35·9) between centres, with a two-times higher probability of receiving acute surgery for an identical patient in one centre versus another centre at random (adjusted MOR for acute surgery 1·8; p<0·0001]). Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome (common OR per 23·6% [IQR increase] more acute surgery in a centre 0·92, 95% CI 0·77–1·09). Interpretation Our findings show that treatment for patients with acute subdural haematoma with similar characteristics differed depending on the treating centre, because of variation in the preferred approach. A treatment strategy preferring an aggressive approach of acute surgical evacuation over initial conservative treatment was not associated with better functional outcome. Therefore, in a patient with acute subdural haematoma for whom a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered. Funding The Hersenstichting Nederland (also known as the Dutch Brain Foundation), the European Commission Seventh Framework Programme, the Hannelore Kohl Stiftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA), and NeuroTrauma Sciences (USA).

• Helmrich, Isabel Retel; Czeiter, Endre; Amrein, Krisztina; Büki, András; Lingsma, Hester F & Menon, David K [Show all 50 contributors for this article] (2022). Incremental prognostic value of acute serum biomarkers for functional outcome after traumatic brain injury (CENTER-TBI): an observational cohort study. Lancet Neurology. ISSN 1474-4422. 21(9), p. 792–802. doi: 10.1016/S1474-4422(22)00218-6. Full text in Research Archive Show summary

  Background Several studies have reported an association between serum biomarker values and functional outcome following traumatic brain injury. We aimed to examine the incremental (added) prognostic value of serum biomarkers over demographic, clinical, and radiological characteristics and over established prognostic models, such as IMPACT and CRASH, for prediction of functional outcome. Methods We used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study. We included patients aged 14 years or older who had blood sampling within 24 h of injury, results from a CT scan, and outcome assessment according to the Glasgow Outcome Scale-Extended (GOSE) at 6 months. Amounts in serum of six biomarkers (S100 calcium-binding protein B, neuron-specific enolase, glial fibrillary acidic protein, ubiquitin C-terminal hydrolase L1 [UCH-L1], neurofilament protein-light, and total tau) were measured. The incremental prognostic value of these biomarkers was determined separately and in combination. The primary outcome was the GOSE 6 months after injury. Incremental prognostic value, using proportional odds and a dichotomised analysis, was assessed by delta C-statistic and delta R2 between models with and without serum biomarkers, corrected for optimism with a bootstrapping procedure. Findings Serum biomarker values and 6-month GOSE were available for 2283 of 4509 patients. Higher biomarker levels were associated with worse outcome. Adding biomarkers improved the C-statistic by 0·014 (95% CI 0·009–0·020) and R2 by 4·9% (3·6–6·5) for predicting GOSE compared with demographic, clinical, and radiological characteristics. UCH-L1 had the greatest incremental prognostic value. Adding biomarkers to established prognostic models resulted in a relative increase in R2 of 48–65% for IMPACT and 30–34% for CRASH prognostic models. Interpretation Serum biomarkers have incremental prognostic value for functional outcome after traumatic brain injury. Our findings support integration of biomarkers—particularly UCH-L1—in established prognostic models. Funding European Union's Seventh Framework Programme, Hannelore Kohl Stiftung, OneMind, Integra LifeSciences, and NeuroTrauma Sciences

• Åkerlund, Cecilia; Holst, Anders; Stocchetti, Nino; Steyerberg, Ewout W; Menon, David K & Ercole, Ari [Show all 50 contributors for this article] (2022). Clustering identifies endotypes of traumatic brain injury in an intensive care cohort: a CENTER-TBI study. Critical Care. ISSN 1364-8535. 26. doi: 10.1186/s13054-022-04079-w. Full text in Research Archive Show summary

  Background While the Glasgow coma scale (GCS) is one of the strongest outcome predictors, the current classification of traumatic brain injury (TBI) as ‘mild’, ‘moderate’ or ‘severe’ based on this fails to capture enormous heterogeneity in pathophysiology and treatment response. We hypothesized that data-driven characterization of TBI could identify distinct endotypes and give mechanistic insights. Methods We developed an unsupervised statistical clustering model based on a mixture of probabilistic graphs for presentation (< 24 h) demographic, clinical, physiological, laboratory and imaging data to identify subgroups of TBI patients admitted to the intensive care unit in the CENTER-TBI dataset (N = 1,728). A cluster similarity index was used for robust determination of optimal cluster number. Mutual information was used to quantify feature importance and for cluster interpretation. Results Six stable endotypes were identified with distinct GCS and composite systemic metabolic stress profiles, distinguished by GCS, blood lactate, oxygen saturation, serum creatinine, glucose, base excess, pH, arterial partial pressure of carbon dioxide, and body temperature. Notably, a cluster with ‘moderate’ TBI (by traditional classification) and deranged metabolic profile, had a worse outcome than a cluster with ‘severe’ GCS and a normal metabolic profile. Addition of cluster labels significantly improved the prognostic precision of the IMPACT (International Mission for Prognosis and Analysis of Clinical trials in TBI) extended model, for prediction of both unfavourable outcome and mortality (both p < 0.001). Conclusions Six stable and clinically distinct TBI endotypes were identified by probabilistic unsupervised clustering. In addition to presenting neurology, a profile of biochemical derangement was found to be an important distinguishing feature that was both biologically plausible and associated with outcome. Our work motivates refining current TBI classifications with factors describing metabolic stress. Such data-driven clusters suggest TBI endotypes that merit investigation to identify bespoke treatment strategies to improve care.

• Whitehouse, Daniel; Monteiro, Miguel; Czeiter, Endre; Vyvere, Thijs Vande; Valerio, Fernanda & Ye, Zheng [Show all 50 contributors for this article] (2022). Relationship of admission blood proteomic biomarkers levels to lesion type and lesion burden in traumatic brain injury: A CENTER-TBI study. EBioMedicine. 75, p. 1–15. doi: 10.1016/j.ebiom.2021.103777. Full text in Research Archive Show summary

  Background We aimed to understand the relationship between serum biomarker concentration and lesion type and volume found on computed tomography (CT) following all severities of TBI. Methods Concentrations of six serum biomarkers (GFAP, NFL, NSE, S100B, t-tau and UCH-L1) were measured in samples obtained <24 hours post-injury from 2869 patients with all severities of TBI, enrolled in the CENTER-TBI prospective cohort study (NCT02210221). Imaging phenotypes were defined as intraparenchymal haemorrhage (IPH), oedema, subdural haematoma (SDH), extradural haematoma (EDH), traumatic subarachnoid haemorrhage (tSAH), diffuse axonal injury (DAI), and intraventricular haemorrhage (IVH). Multivariable polynomial regression was performed to examine the association between biomarker levels and both distinct lesion types and lesion volumes. Hierarchical clustering was used to explore imaging phenotypes; and principal component analysis and k-means clustering of acute biomarker concentrations to explore patterns of biomarker clustering. Findings 2869 patient were included, 68% (n=1946) male with a median age of 49 years (range 2-96). All severities of TBI (mild, moderate and severe) were included for analysis with majority (n=1946, 68%) having a mild injury (GCS 13-15). Patients with severe diffuse injury (Marshall III/IV) showed significantly higher levels of all measured biomarkers, with the exception of NFL, than patients with focal mass lesions (Marshall grades V/VI). Patients with either DAI+IVH or SDH+IPH+tSAH, had significantly higher biomarker concentrations than patients with EDH. Higher biomarker concentrations were associated with greater volume of IPH (GFAP, S100B, t-tau;adj r2 range:0·48-0·49; p<0·05), oedema (GFAP, NFL, NSE, t-tau, UCH-L1;adj r2 range:0·44-0·44; p<0·01), IVH (S100B;adj r2 range:0.48-0.49; p<0.05), Unsupervised k-means biomarker clustering revealed two clusters explaining 83·9% of variance, with phenotyping characteristics related to clinical injury severity. Interpretation Interpretation: Biomarker concentration within 24 hours of TBI is primarily related to severity of injury and intracranial disease burden, rather than pathoanatomical type of injury. Funding CENTER-TBI is funded by the European Union 7th Framework programme (EC grant 602150).

• Rivera, Diego; Greving, Sven; Arango-Lasprilla, Juan Carlos; Steinbuechel, Nicole von; Zeldovich, Marina & Åkerlund, Cecilia [Show all 85 contributors for this article] (2022). Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study. Journal of Clinical Medicine. 11(14), p. 1–23. doi: 10.3390/jcm11144090. Full text in Research Archive Show summary

  settingsOrder Article Reprints Open AccessArticle Comparability of (Post-Concussion) Symptoms across Time in Individuals after Traumatic Brain Injury: Results from the CENTER-TBI Study by Diego Rivera 1,2ORCID,Sven Greving 3,Juan Carlos Arango-Lasprilla 4ORCID,Nicole von Steinbuechel 3,Marina Zeldovich 3,*ORCID andCENTER-TBI Participants and Investigators † 1 Department of Health Sciences, Public University of Navarre, Arrosadia Campus, 31006 Pamplona, Spain 2 Instituto de Investigación Sanitaria de Navarra (IdiSNA), Irunlarrea Street 3, 31008 Pamplona, Spain 3 Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany 4 Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA * Author to whom correspondence should be addressed. † The full list of the CENTER-TBI participants and investigators can be found in the Supplementary Materials. J. Clin. Med. 2022, 11(14), 4090; https://doi.org/10.3390/jcm11144090 Received: 20 May 2022 / Revised: 10 July 2022 / Accepted: 13 July 2022 / Published: 14 July 2022 (This article belongs to the Special Issue Traumatic Brain Injury: Diagnosis, Management, and Outcomes) Download Browse Figures Versions Notes Abstract Post-concussion symptoms often occur after TBI, persist and cause disabilities. The Rivermead Post-Concussion Symptoms Questionnaire (RPQ) is widely used in this population, but little is known about the comparability of the symptoms over time, i.e., longitudinal measurement invariance (MI). The objectives of this study were to analyze the longitudinal MI of RPQ symptoms from three to twelve months after TBI and to find factors related to RPQ symptoms. The study involved 1023 individuals after TBI who took part in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study and completed the RPQ at three, six and twelve months post-injury. Longitudinal confirmatory factor analysis showed that the three-factor structure (somatic, emotional and cognitive) remains stable within one year after TBI. Linear mixed models revealed that sex, injury cause and prior psychiatric problems were related to the RPQ three-factor structure as well as to the RPQ total score. The study strengthens evidence for the RPQ’s factorial structure stability within one year after TBI and identifies sex, injury cause and prior psychiatric problems as important factors that may help clinicians to prevent future complications of symptomatology after TBI.

• Volovici, Victor; Pisică, Dana; Gravesteijn, Benjamin; Dirven, Clemens M. F.; Steyerberg, Ewout W. & Ercole, Ari [Show all 50 contributors for this article] (2022). Comparative effectiveness of intracranial hypertension management guided by ventricular versus intraparenchymal pressure monitoring: a CENTER-TBI study. Acta Neurochirurgica. ISSN 0001-6268. 164, p. 1693–1705. doi: 10.1007/s00701-022-05257-z. Full text in Research Archive Show summary

  Objective To compare outcomes between patients with primary external ventricular device (EVD)–driven treatment of intracranial hypertension and those with primary intraparenchymal monitor (IP)–driven treatment. Methods The CENTER-TBI study is a prospective, multicenter, longitudinal observational cohort study that enrolled patients of all TBI severities from 62 participating centers (mainly level I trauma centers) across Europe between 2015 and 2017. Functional outcome was assessed at 6 months and a year. We used multivariable adjusted instrumental variable (IV) analysis with “center” as instrument and logistic regression with covariate adjustment to determine the effect estimate of EVD on 6-month functional outcome. Results A total of 878 patients of all TBI severities with an indication for intracranial pressure (ICP) monitoring were included in the present study, of whom 739 (84%) patients had an IP monitor and 139 (16%) an EVD. Patients included were predominantly male (74% in the IP monitor and 76% in the EVD group), with a median age of 46 years in the IP group and 48 in the EVD group. Six-month GOS-E was similar between IP and EVD patients (adjusted odds ratio (aOR) and 95% confidence interval [CI] OR 0.74 and 95% CI [0.36–1.52], adjusted IV analysis). The length of intensive care unit stay was greater in the EVD group than in the IP group (adjusted rate ratio [95% CI] 1.70 [1.34–2.12], IV analysis). One hundred eighty-seven of the 739 patients in the IP group (25%) required an EVD due to refractory ICPs. Conclusion We found no major differences in outcomes of patients with TBI when comparing EVD-guided and IP monitor–guided ICP management. In our cohort, a quarter of patients that initially received an IP monitor required an EVD later for ICP control. The prevalence of complications was higher in the EVD group.

• Finstad, Jeanette; Røise, Olav; Rosseland, Leiv Arne; Clausen, Thomas & Havnes, Ingrid Amalia (2021). Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 29(1), p. 1–12. doi: 10.1186/s13049-021-00938-7. Full text in Research Archive Show summary

  Background Physical trauma is associated with mortality, long-term pain and morbidity. Effective pain management is fundamental in trauma care and opioids are indispensable for treating acute pain; however, the use and misuse of prescribed opioids is an escalating problem. Despite this, few studies have been directed towards trauma patients in an early phase of rehabilitation with focusing on experiences and perspectives of health and recovery including pain and persistent use of prescribed opioids with abuse potential. To explore pre- and post-discharge trauma care experiences, including exposure to opioids, physical trauma survivors were recruited from a major trauma centre in Norway that provides the highest level of surgical trauma care. Method Qualitative exploratory study. Individual semi-structured interviews were conducted among 13 trauma patients with orthopedic injuries, known to be associated with severe pain, six weeks post-discharge. The interviews were recorded, transcribed verbatim, and thematically analyzed with an interdisciplinary approach. Results The overarching theme was that discharge from the trauma centre and the period that immediately followed were associated with feelings of insecurity. The three main themes that were identified as contributing to this was (a) unmet information needs about the injury, (b) exposure to opioids, and (c) lack of follow-up after discharge from the hospital. Participants experienced to be discharged with prescribed opioids, but without information about their addictive properties or tapering plans. This, and lack of attention to mental health and psychological impact of trauma, gave rise to unmet treatment needs of pain management and mental health problems during hospitalization and following discharge. Conclusion The findings from this study suggest that in addition to delivery of high-quality biomedical trauma care, health professionals should direct more attention to psychosocial health and safe pain management, including post-discharge opioid tapering and individually tailored follow-up plans for physical trauma survivors.

• Andelic, Nada; Røe, Cecilie; Tenovuo, Olli; Azouvi, Philippe; Dawes, Helen & Majdan, Marek [Show all 56 contributors for this article] (2021). Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study. Journal of Clinical Medicine. 10(5). doi: 10.3390/jcm10051035. Full text in Research Archive Show summary

  This study aims to assess rehabilitation needs and provision of rehabilitation services for individuals with moderate-to-severe disability and investigate factors influencing the probability of receiving rehabilitation within six months after traumatic brain injury (TBI). Overall, the analyses included 1206 individuals enrolled in the CENTER-TBI study with severe-to-moderate disability. Impairments in five outcome domains (daily life activities, physical, cognition, speech/language, and psychological) and the use of respective rehabilitation services (occupational therapy, physiotherapy, cognitive and speech therapies, and psychological counselling) were recorded. Sociodemographic and injury-related factors were used to investigate the probability of receiving rehabilitation. Physiotherapy was the most frequently provided rehabilitation service, followed by speech and occupational therapy. Psychological counselling was the least frequently accessed service. The probability of receiving a rehabilitative intervention increased for individuals with greater brain injury severity (odds ratio (OR) 1.75, CI 95%: 1.27–2.42), physical (OR 1.92, CI 95%: 1.21–3.05) and cognitive problems (OR 4.00, CI 95%: 2.34–6.83) but decreased for individuals reporting psychological problems (OR 0.57, CI 95%: 1.21–3.05). The study results emphasize the need for more extensive prescription of rehabilitation services for individuals with disability. Moreover, targeted rehabilitation programs, which aim to improve outcomes, should specifically involve psychological services to meet the needs of individuals recovering from TBI.

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• Hesjevoll, Ingeborg Storesund; Røise, Olav & Bjørnskau, Torkel (2026). When Police and Clinical Severity Diverge: Injury patterns and implications for Norway’s Transition to AIS-Based Serious-Injury Monitoring. Full text in Research Archive
• Hesjevoll, Ingeborg Storesund; Bjørnskau, Torkel & Røise, Olav (2026). When Police and Clinical Severity Diverge: Injury patterns and implications for Norway’s Transition to AIS-Based Serious-Injury Monitoring. International Transport Forum (ITF) Discussion Papers. p. 1–4. Full text in Research Archive
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  Forskning er viktig for at vi skal kunne gi best mulig behandling. Men forslaget til ny helseforskningslov kan bidra til dårligere kvalitet på forskningen og svekket pasientsikkerhet.

• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn Johannes Bernardus; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Kartlegging av peritraumatisk opioidbruk ved bruk av multistate-modellering: En populasjonsbasert kohortstudie. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn Johannes Bernardus; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Kartlegging av peritraumatisk opioidbruk ved bruk av multistate-modellering: En populasjonsbasert kohortstudie . Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn Johannes Bernardus; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A population-based retrospective cohort study. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among trauma patients: A national retrospective cohort study. Full text in Research Archive
• Engel, Sophia; Rosseland, Leiv Arne; Smits, Martijn; Skurtveit, Svetlana Ondrasova; Gran, Jon Michael & Nordseth, Trond [Show all 8 contributors for this article] (2024). Peritraumatic patterns of opioid use among Norwegian trauma patients: A national retrospective cohort study. Full text in Research Archive
• Seljemo, Camilla; Ree, Eline; Røise, Olav & Wiig, Siri (2024). Managers` leveraging reflexive spaces in resilient healthcare. Full text in Research Archive
• Olsen, Ingri Grimnes; Garratt, Andrew; Woodhouse, Astrid; Stedenfeldt, Mona; Nøst, Torunn Hatlen & Røise, Olav [Show all 8 contributors for this article] (2024). Feasibility of electronic patient reported outcome measures in trauma patients. Full text in Research Archive
• Rasmussen, Mari Storli; Andelic, Nada; Selj, Joanna Nordhagen; Danielsen, Vilde Marie; Løvstad, Marianne & Howe, Emilie Isager [Show all 30 contributors for this article] (2024). Self-management support program delivered in the sub-acute phase after traumatic injury-study protocol for a pragmatic randomized controlled trial. Trials. 25(1), p. 639–639. doi: 10.1186/s13063-024-08492-0. Full text in Research Archive Show summary

  Background Traumatic injuries, defined as physical injuries with sudden onset, are a major cause of distress and disability, with far-reaching societal consequences. A significant proportion of trauma survivors report persistent symptoms and difficulties after the injury, and studies show unmet health care needs. Self-management programs delivered in the sub-acute phase after traumatic injuries are scarcely evaluated. The aim of the present study is to evaluate the effectiveness of a self-management program (SEMPO), delivered 3–4 months after moderate-to-severe traumatic injury. Methods This study protocol describes a pragmatic randomized controlled trial (RCT) with two classical RCT arms (intervention and control) and an explorative self-selection arm. 220 patients will be recruited from Oslo University Hospital, the largest Trauma Referral Centre in Norway. Patients aged 18–72 years residing in the south-east region of Norway, admitted to the Trauma Centre directly or within 72 h after having sustained a moderate to severe traumatic injury, defined as a New Injury Severity Score > 9, having at least 2 days hospital stay, and reporting injury-related symptoms and impairment at discharge from the acute hospital will be included. Patients will be randomly assigned to either a classical RCT randomization arm (intervention or control arm) or to a self-selection arm. In the randomization arm, participants are further randomized into intervention or control group. Participants allocated to the self-selection arm will choose to partake either in the intervention or control arm. The primary outcome is the level of self-efficacy in trauma coping assessed 6 months after completion of the intervention, with a similar time point for the control group. Secondary outcomes include symptom burden, physical functioning and disability, return to work and health care utilization, health-related quality of life, and communication competency. In addition, patients will be asked to nominate one domain-related measurement as their preferred outcome measure. Discussion This RCT will determine the effect of a self-management program tailored to patients with moderate to severe physical trauma, and the self-selection arm incorporates the potential influence of patient treatment preferences on intervention results. If the intervention proves effective, cost-effectiveness and cost-utility analyses will be performed and thereby provide important information for clinicians and policy makers. Trial registration The study is registered in Clinical Trials with the identifier: NCT06305819. Registered on March 05, 2004.

• Olsen, Ingri Grimnes; Garratt, Andrew; Woodhouse, Astrid; Stedenfeldt, Mona; Nøst, Torunn Hatlen & Røise, Olav [Show all 8 contributors for this article] (2024). Feasibility of electronic patient reported outcome measures in trauma patients. Full text in Research Archive
• Seljemo, Camilla; Wiig, Siri; Røise, Olav & Ree, Eline (2023). The role of local context for managers` strategies when adapting to the COVID-19 pandemic. Managerial strategies across system levels in Norwegian homecare services. Full text in Research Archive
• Uleberg, Oddvar; Majeed, Waleed Mohammed; Hoås, Einar Frigstad & Røise, Olav (2023). Compliance to national trauma triage criteria in Norway - a cross-sectional study. Full text in Research Archive
• Seljemo, Camilla; Wiig, Siri; Røise, Olav & Ree, Eline (2023). Exploring managers` role in resilient healthcare during the COVID-19 pandemic in Norwegian homecare services. A- multiple embedded case study. Full text in Research Archive
• Nortvedt, Per; Røise, Olav; Rostoft, Siri & Pedersen, Reidar (2022). Man bryr seg mindre jo mer man gjør det. 142(18), p. 1538–1538. doi: 10.4045/tidsskr.22.0667. Full text in Research Archive
• Søberg, Helene L.; Moksnes, Håkon Øgreid; Anke, Audny Gabriele Wagner; Røise, Olav; Røe, Cecilie & Aas, Eline [Show all 20 contributors for this article] (2022). Erratum: Rehabilitation Needs, Service Provision, and Costs in the First Year following Traumatic Injuries: Protocol for a Prospective Cohort Study ((JMIR Res Protoc (2021) 10: 4 (e25980) DOI: 10.2196/25980). JMIR Research Protocols. 11(3). doi: 10.2196/37723. Full text in Research Archive
• Rasmussen, Anders; Stenehjem, Jo Steinson; Røise, Olav; Gran, Jon Michael; Kristiansen, Thomas & Uleberg, Oddvar [Show all 8 contributors for this article] (2022). Standardised mortality rates for non-traumatic deaths among survivors of trauma in Norway (2015-2018). Full text in Research Archive
• Uleberg, Oddvar; Naberezhneva, Natalia; Dahlhaug, Marianne; Giil-Jensen, Vigdis; Ringdal, Kjetil G. & Røise, Olav (2022). Excellent agreement of Norwegian Trauma Registry data compared to corresponding data in electronic patient records. Full text in Research Archive
• Andersen, Nina Gjerde; Dahlhaug, Marianne; Røise, Olav; Nordseth, Trond; Rosseland, Leiv Arne & Uleberg, Oddvar (2022). Patient reported outcomes from the Norwegian Trauma Registry. Full text in Research Archive
• Seljemo, Camilla; Wiig, Siri; Røise, Olav & Ree, Eline (2022). The role of local context for managers` experiences and strategies applied when adapting to the COVID-19 pandemic in Norwegian homecare services - A multiple case study in four Norwegian municipalities. Full text in Research Archive
• Uleberg, Oddvar; Kristiansen, Thomas; Nordseth, Trond; Stenehjem, Jo S.; Gran, Jon Michael & Clausen, Thomas [Show all 8 contributors for this article] (2022). Skader etter vold og ulykker - den glemte pandemi? 142(8), p. 678–679. doi: 10.4045/tidsskr.22.0261. Full text in Research Archive
• Dahlhaug, Marianne; Uleberg, Oddvar & Røise, Olav (2022). Bruk av pasientrapporterte data fra Nasjonalt Traumeregister. Full text in Research Archive
• Dahlhaug, Marianne; Uleberg, Oddvar & Røise, Olav (2022). Bruk av pasientrapporterte data fra Nasjonalt Traumeregister. Full text in Research Archive
• Glette, Malin Knutsen; Kringeland, Tone Åslaug; Røise, Olav & Wiig, Siri (2022). Helsepersonells erfaringer med reinnleggelser fra primærhelsetjenesten – en oppsummering av en casestudie. Tidsskrift for omsorgsforskning. ISSN 2387-5976. p. 1–10. doi: 10.18261/tfo.8.1.4. Full text in Research Archive
• Cuevas-Østrem, Mathias; Wisborg, Torben; Røise, Olav & Jeppesen, Elisabeth (2022). Older trauma patients are less likely to receive advanced prehospital care: A study from the Norwegian Trauma Registry. Full text in Research Archive
• Uleberg, Oddvar; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2022). The injury prevention and outcomes following trauma (IPOT) project: is a nationwide registry-based study in Norway feasible? Full text in Research Archive
• Stenehjem, Jo S.; Røise, Olav; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2021). Injury Prevention and long-term Outcomes following Trauma - the IPOT project: a protocol for prospective nationwide registry-based studies in Norway. Full text in Research Archive
• Rosseland, Leiv Arne; Stenehjem, Jo S.; Nordseth, Trond; Clausen, Thomas; Natvig, Bård & Skurtveit, Svetlana Ondrasova [Show all 12 contributors for this article] (2021). The Injury Prevention and Outcomes following Trauma project: a prospective nationwide registry-based study in Norway. Full text in Research Archive
• Seljemo, Camilla; Ree, Eline; Wiig, Siri & Røise, Olav (2025). Exploring homecare managers’ role in resilient healthcare during the COVID-19 pandemic: A multiple embedded case study. Universitetet i Stavanger. ISSN 9788284394206. Full text in Research Archive Show summary

  Introduction: The COVID-19 pandemic has been one of the most significant challenges faced by healthcare systems in modern times, with homecare services playing a critical role in the delivery of care to patients at home. Providing healthcare in homecare settings is inherently complicated, given the combination of patients’ often complex medical conditions, the use of advanced technologies, and the limited support available from managers and colleagues due to remote working conditions. During the pandemic, homecare staff faced numerous challenges that required continuous adaptation to maintain essential healthcare services. Managers’ capacity to respond to disruptions and support frontline staff was crucial for ensuring safe and effective care. Homecare managers faced a range of organizational challenges that threatened service quality, requiring flexible, innovative, and adaptive strategies. These practices reflect the core characteristics of resilience in healthcare organizations: the capacity to respond to uncertainty, adapt, and maintain effective functioning amid adversity. However, gaps remain in our understanding of the specific strategies managers employ across system levels, how they foster organizational learning, and how they contribute to resilient healthcare delivery within the homecare sector in times of crisis. Aim: The overarching aim of this thesis was to advance the understanding of managers’ role in fostering resilience within homecare services by exploring the strategies employed at different managerial levels in response to the challenges of the COVID-19 pandemic. This exploration was conducted from the perspectives of both homecare managers and healthcare staff. A secondary aim was to investigate how managers facilitated spaces for reflection and knowledge-sharing, referred to as “reflexive spaces”, and how these spaces contributed to support resilience performance during the pandemic. Methods: This thesis employed a multiple embedded case study design, comprising three qualitative studies that explored managerial strategies in homecare services during the COVID-19 pandemic, from the perspectives of both managers and frontline staff. The study included four municipalities of various sizes and geographical contexts (urban, rural, centralized, and decentralized). Each case was defined as a municipality’s homecare unit, comprising embedded units at several levels: micro-level healthcare staff, meso-level managers (frontline, middle, and top), and the municipality’s infection control doctor. Data were collected through individual semi-structured interviews with 21 managers and 16 healthcare staff. All data were subjected to thematic analysis. Results: Paper I (meso-level) explored which strategies managers applied in adapting to challenges while maintaining high-quality and safe homecare services during the COVID-19 pandemic, and how their experiences and strategies were shaped by the local context. The analysis identified four main themes: 1) managerial strategies to mitigate shortages of healthcare staff; 2) contingency planning strategies and infection control; 3) strategies for collaboration, dialogue and coordinated responses across levels; and 4) supportive and present leadership. The local context was important for managers experiences and which strategies they applied in response to the challenges caused by the pandemic. Paper II (micro-level) explored healthcare staff’s experiences of how their managers adapted and responded to the challenges posed by the pandemic in homecare services. The analysis identified the following three themes: 1) proactive managers’ preparedness and response to challenges despite uncertainty; 2) the importance of targeted and effective information between system levels; and 3) physically present managers made employees feel seen, heard and involved. Paper III (micro- and meso-level) explored how managers facilitated knowledge-sharing and joint reflections and how these “reflexive spaces” contributed to adapting to the pandemic. The analysis identified two main themes 1) arenas for reflection, communication and dialogue and 2) establishing new solutions through collective reflection facilitated by managers. The synthesis of findings across the three papers identified six themes that explain homecare managers’ role in resilient healthcare during the COVID-19 pandemic: 1) proactively responding despite uncertainty; 2) driving crisis innovation; 3) being present, available and supportive; 4) adapting to local context; 5) ensuring collaboration and information across levels and boundaries; and 6) enabling collective reflection, problem-solving and learning. Conclusion: This thesis uses a resilience perspective to generate valuable insights into Norwegian homecare service managers’ role in handling a pandemic. Managers at all levels of the organization faced continuous and complex Challenges that threatened the delivery of highquality and safe care. In response, they demonstrated adaptability both within and across levels by making sense of evolving situations, monitoring developments, and anticipating potential scenarios. This enabled them to mobilize and innovate using both existing and new resources. At the same time, they evaluated and improved their strategies and enabled learning across levels and boundaries, allowing for restructuring and reorganizing the system to better prepare the system for future responses to challenges. This emphasizes the importance of managers in enabling organizational learning and system-level interaction during a crisis. Future efforts should aim to support and strengthen local adaptive strategies in response to emerging challenges, with a particular emphasis on cross-level and cross-context learning to drive system-wide improvement.

• Jeppesen, Elisabeth; Wisborg, Torben; Røise, Olav & Cuevas-Østrem, Mathias (2024). Assessing patient safety challenges in the initial care of older trauma patients in Norway. Universitetet i Stavanger. ISSN 9788284392066. Full text in Research Archive Show summary

  Denne avhandlingen bygger på ett enkelt premiss: eldre pasienter har rett til akuttbehandling av høy kvalitet når de blir alvorlig syke eller skadde. Traumesystemer gir pasienter de beste sjansene for å overleve med god livskvalitet etter alvorlige skader, også for eldre pasienter. Disse systemene har som mål å skape sømløs informasjons- og behandlingsflyt fra skadestedet til rehabilitering. Planen som beskriver systemet, stiller like krav til prehospitale og inhospitale tjenester over hele landet. Det norske traumesystemet skal ivareta alle pasienter med alvorlige skader, uavhengig av bakgrunn eller hvor de skades. Imidlertid har studier fra sammenlignbare traumesystemer internasjonalt avdekket bekymringsfulle ulikheter i traumeomsorgen for eldre, og spesifikt de med alvorlige hodeskader. Derfor var målet med denne avhandlingen å vurdere om det eksisterer utfordringer knyttet til pasientsikkerhet i den initiale behandlingen av eldre traumepasienter i Norge. Gjennom analyser av data fra Nasjonalt Traumeregister og fokusgruppeintervjuer med involverte klinikere, har denne avhandlingen identifisert utfordringer knyttet til pasientsikkerhet i det nåværende systemet, men også styrker. To studier fokuserte på epidemiologien til og behandlingen av den generelle traumepopulasjonen, og sammenlignet eldre og yngre voksne. De påfølgende to studiene fokuserte på pasienter med isolerte hodeskader som ble innlagt på ikke-nevrokirurgiske akuttsykehus. Vi undersøkte pasientforløp og hvilke faktorer som påvirket beslutningen om å overføre pasienter mellom sykehus, inkludert rollen til alder og tidligere sykdommer. Våre studier avdekket i hovedsak utfordringer knyttet til prehospital behandling. Eldre traumepasienter fikk sjeldnere avansert prehospital behandling, til tross for sammenlignbar skadealvorlighetsgrad. De ble sjeldnere møtt av et team med lege og paramedisiner, fikk sjeldnere avanserte intervensjoner og ble sjeldnere transportert med luftambulanse. Ved sykehusinnleggelse ble de sjeldnere møtt av et traumeteam og hadde lavere innleggelsesrater i traumesentre. Vi fant at mer enn en tredjedel av eldre traumepasienter hadde alvorlige hodeskader. Eldre pasienter ble sjeldnere intubert før ankomst på sykehus, til tross for en Glasgow Coma Scale score under 9. Videre observerte vi at eldre pasienter med isolerte moderate til alvorlige hodeskader i større grad ble henvist til ikke-nevrokirurgiske sykehus som primærsykehus, sammenlignet med yngre pasienter. Faktorer som alder, tidligere sykdommer og funksjonsnedsettelser før skaden, reduserte sannsynligheten for overføring til et nevrotraumesenter. Den komplekse beslutningsprosessen rundt overføring var også sårbar for kommunikasjonsfeil. Imidlertid identifiserte våre studier også viktige styrker ved det nåværende systemet. Når et traumeteam ble aktivert ved sykehusinnleggelse, var det få klinisk signifikante forskjeller i behandlingen mellom unge og eldre voksne. Og klinikere forsøkte å ta pasient-sentrerte beslutninger om hvem som skulle overføres for spesialisert nevrotraumebehandling basert på individuelle pasienters helsetilstand og sjanser for positive resultater. Dette arbeidet er den første større studien av pasientsikkerhetsutfordringer for eldre traumepasienter i Norge. Arbeidet har bekreftet at utfordringer knyttet til pasientsikkerhet, som er vist i studier fra andre land, også eksisterer her, i en skandinavisk sammenheng preget av et offentlig finansiert helsevesen. Videre har det gitt ny innsikt om bruken av lege-paramedisiner-team i omsorgen for eldre traumepasienter. Det har også bidratt med kunnskap om behandling av eldre pasienter med hodeskader i velutviklede traumesystemer, og dermed styrket et internasjonalt forskningsfelt i utvikling. Å avdekke problemer innenfor et system fungerer som en grunnstein for å løse dem. I dette perspektivet belyser denne avhandlingen ikke bare eksisterende utfordringer, men legger også kursen for fremtidig innsats: det bør forskes videre på bedre systemer for utkall av prehospitale ressurser, beslutningsstøtte for prehospitalt personell og forbedret kommunikasjon mellom sykehusene knyttet til overføring av hodeskadepasienter. I en nært forestående framtid hvor befolkningen eldes og presset på helseressursene øker, blir viktigheten av god ressursallokering og god behandling av eldre enda mer påtrengende. Disse målene er oppnåelige gjennom fortsatt forbedring av traumesystemet.

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