PhD Defence Eveline Wiegers

Traumatic Brain Injury (TBI) and stroke are major public health concerns and these patients are often admitted to neurocritical care for intensive monitoring and treatments. Comparative Effectiveness Research has been proposed to study the effect treatments and management strategies for patients admitted to neurocritical care. The objective of this thesis was to describe the contemporary landscape of neurocritical care in Europe and Australia and to assess the effectiveness and quality of neurocritical care. This research was part of the CENTER-TBI study and the OzENTER-TBI study, prospective observational cohort studies of patients with TBI in Europe, Israel and Australia and the MR CLEAN study, a Dutch collaboration of patients with ischemic stroke that are treat with Endovascular Thrombectomy. Results from this thesis demonstrated that compared to previous studies, patients with TBI in neurocritical care are older, more often have mild TBI and a substantial part stays in the ICU for less than 72 hours. We observed large variation between centres, regions, and countries regarding to case-mix, specific interventions, and management aspects in neurocritical care, but variation in outcome between centres and countries were smaller. In critically ill patients with TBI, more positive fluid balances were associated with worse outcomes.