PhD defence E. (Ernest) van Veen

Below is a brief summary about the dissertation:

In this thesis we described international perspectives on ethical and medical decisions in TBI, based on both perceptional data, and actual patient data, between Europe and China and within Europe. We found variation in both the perception of management and treatments of patients and in the actual treatments of patients. Variation in the intensity of treatment is possibly related to outcomes in older patients who sustained a TBI, but variation in the use of mannitol and HTS was not related to outcomes. Variation between centers and patients was also found for end-of-life practices such as the determination of brain death, the occurrence of withdrawing LSM, and the timing of withdrawing LSM. The variation we identified indicate important areas for future research. 

The studies in this thesis have improved insights in end-of-life practices, in treatment differences, and in the implications these treatment differences have for (long-term) outcomes. Despite difficulties in establishing causal effects, the observational design of the CENTERTBI study used in this thesis, ensured larger generalizability of the results compared to an RCT with strict enrollment criteria. Moreover, new areas for future research and subsequent improvement have been identified. Using international collaborations, a vast amount of patient data, and a combination of quantitative and qualitative research methods, new steps in the best treatment for patients who sustained a TBI can be made.