PhD defence I.R.A. (Isabel) Retel Helmrich

Below is a brief summary of the dissertation:

Over the past 4 years, I have studied prediction of outcomes for patients in acute care. A prediction of the risk of future conditions, such as a patient's health or wellbeing, is called a prognosis. In clinical practice, health care providers frequently aim to predict a future outcome of an individual patient. The ability to accurately predict a patient’s outcome is important and has several purposes. A prognosis can be used in communication with patients and relatives, it can support clinical decisions, and it can be used for risk stratification in research and for quality-of-care assessments.

In the hospital, acute care services are provided to a patient with a severe illness or condition. Patients are, for instance, treated briefly for a severe illness or condition that resulted from a disease or trauma at the emergency department or in the intensive care unit. A considerable proportion of this thesis came into being during the COVID-19 pandemic, in which research on COVID-19 emerged rapidly and took priority. Therefore, we will predominantly focus on traumatic brain injury, while also including results from a study on COVID-19 care.

Traumatic brain injury (TBI) can be defined as an injury to the brain induced by an external force and is a major health concern with over 50,000,000 new cases reported globally every year. There has been considerable interest in prognosis following TBI. TBI is said to be one of the most heterogeneous neurological conditions, which makes the prediction of outcome challenging. It is important to identify patients who are at high risk of mortality or long-term consequences. Accurate and reliable prognostic models for outcome prediction after TBI have the potential to support health care providers and patients in making clinical decisions. Improving prognostication has been considered critical by health care providers, researchers, and patients and caregivers alike.

Aim of this thesis:
The overall aim of this thesis is to increase our knowledge of prediction of outcome in acute care by exploring methodological aspects (Part I) and applications (Part II) of prognostic research. In this thesis we mainly made use of data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study. The CENTER-TBI study is a large prospective observational cohort study including 4509 patients with mild, moderate and severe TBI.