Epidemiology, treatment and outcome of patients after severe traumatic brain injury in European regions with different economic status

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.