The European Journal of Public Health Advance Access published online on September 15, 2008
The European Journal of Public Health, doi:10.1093/eurpub/ckn079
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epidemiology, treatment and outcome of patients after severe traumatic brain injury in European regions with different economic status*
Walter Mauritz1,2, Ingrid Wilbacher2, Marek Majdan3, Johannes Leitgeb4, Ivan Janciak2, Alexandra Brazinova2,3 and Martin Rusnak2,3
1 Trauma Hospital "Lorenz Boehler", Vienna, Austria
2 International Neurotrauma Research Organisation (INRO), Vienna, Austria
3 Department of Public Health, Faculty of Health and Social Services, Trnava University, Slovak Republic
4 Department of Trauma Surgery, University Hospital Vienna, Vienna, Austria
Correspondence: Prof. Walter Mauritz MD, PhD, International Neurotrauma Research Organization, Mölkergasse 4/3, A-1080 Vienna, Austria, tel: +43 699 1008 8502, fax: +43 1 524 5028, e-mail: walter.mauritz{at}igeh.org
Received April 15, 2008 , accepted August 11, 2008
Background: We hypothesized that the economic status of a region might influence quality of care and outcome of patients with severe brain trauma. Methods: Between January 2001 and December 2005, 13 centres enrolled patients with severe brain trauma. Data on accident, treatment and outcomes were collected prospectively. The regions were classified as ‘high income’ (Austria, five centres), ‘upper middle income’ (UMI) (Croatia, Slovakia, six centres) or ‘lower middle income’ (LMI) (Bosnia, Macedonia, two centres). Data on epidemiology, treatment and outcomes were compared according to this classification. Quality of care was assessed using a new scoring system. Results: A total of 1172 data sets were analysed. Patients from the wealthier regions were significantly older. Low-level falls and traffic accidents contributed to more than two-third of all cases. Violence-related trauma was significantly more frequent in ‘middle income’ regions. Treatment quality was significantly different; treatment according to guidelines for brain trauma management was provided most frequently for patients from high-income regions. Compared with expected mortality rates, mortality was 6.5% lower in the ‘high-income’ centres, 2.4% lower in the ‘UMI’ centres and 13% higher in the ‘LMI’ centres. Advanced age, poor neurological status, high trauma severity and poor quality of care were associated with significantly lower odds for survival. Conclusions: The association between the economic status and outcome of brain trauma patients was due to the quality of care. Successful implementation of guidelines for brain trauma management requires a well-funded health care system.
Keywords: gross domestic product, guidelines, traumatic brain injury—epidemiology, traumatic brain injury—treatment, traumatic brain injury—outcome
*Data from this paper will be presented at the Annual EUPHA conference, Lisbon, Portugal, 6–8 November 2008
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Noone Social determinants of health Occup. Med., May 1, 2009; 59(3): 209 - 209. [Full Text] [PDF]
|
|