Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-24T14:17:19.727Z Has data issue: false hasContentIssue false
  • English
  • Français

Overview of Traumatic Brain Injury Patients at a Tertiary Trauma Centre

Published online by Cambridge University Press:  02 December 2014

Elaine de Guise ,
Mitra Feyz ,
Joanne LeBlanc ,
Sylvain-Luc Richard  and
Julie Lamoureux
Elaine de Guise
Affiliation:
Traumatic Brain Injury Program, McGill University Health Centre, Montreal, General Hospital (MUHC-MGH), Montreal, Quebec, Canada
Mitra Feyz
Affiliation:
Traumatic Brain Injury Program, McGill University Health Centre, Montreal, General Hospital (MUHC-MGH), Montreal, Quebec, Canada
Joanne LeBlanc
Affiliation:
Traumatic Brain Injury Program, McGill University Health Centre, Montreal, General Hospital (MUHC-MGH), Montreal, Quebec, Canada
Sylvain-Luc Richard
Affiliation:
Traumatic Brain Injury Program, McGill University Health Centre, Montreal, General Hospital (MUHC-MGH), Montreal, Quebec, Canada
Julie Lamoureux
Affiliation:
Traumatic Brain Injury Program, McGill University Health Centre, Montreal, General Hospital (MUHC-MGH), Montreal, Quebec, Canada
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

The goal of this study was to provide a general descriptive and cognitive portrait of a population with traumatic brain injury (TBI) at the time of their acute care stay.

Material and methods:

Three hundred and forty-eight TBI patients were assessed. The following data were collected for each patient: age, level of education, duration of post-traumatic amnesia, Galveston Orientation Amnesia Test score, Glasgow Coma Scale score, results of cerebral imaging, Neurobehavioral Rating Scale score, the Functional Independence Measure cognitive score and the Glasgow Outcome Scale score.

Results:

The clinical profile of the population revealed a mean age of 40.2 (±18.7) and a mean of 11.5 (±3.6) years of education. Most patients presented with frontal (57.6%) and temporal (40%) lesions. Sixty-two percent had post-traumatic amnesia of less than 24 hours. Seventy percent presented with mild TBI, 14% with moderate and 15% with severe TBI. The cognitive deficits most frequently observed on the Neurobehavioral Rating Scale were in the areas of attention, memory and mental flexibility as well as slowness and mental fatigability. Most patients had good cognitive outcome on the Functional Independence Measure and scores of 2 and 3 were frequent on the GOS. Forty-five percent of the patients returned home after discharge, 51.7% were referred to in or out patient rehabilitation and 3.2% were transferred to long-term care facilities.

Conclusion:

Because of the specialized mandate of acute care institutions, the information provided here concerning characteristics of our TBI population is essential for more efficient decision-making and planning/programming with regards to care and service delivery.

Résumé:

RÉSUMÉ:But:

Le but de cette étude est de présenter le tableau initial tant au plan descriptif que cognitif des traumatisés crâniens (TCs) lors de leur séjour dans un centre de soins actifs.

Matériel et méthodes:

348 TCs ont été évalués. Les données suivantes ont été colligées pour chaque patient : l’âge, le niveau d’instruction, la durée de l’amnésie post-traumatique, le score au test d’orientation et d’amnésie de Galveston, le score à l’échelle de Coma de Glasgow (GCS), les résultats de l’imagerie cérébrale, le score à l’échelle neurocomportementale révisée (NRS), le score cognitif de la mesure d’indépendance fonctionnelle et le score à l’échelle de devenir (issue) de Glasgow (GOS).

Résultats:

La moyenne d’âge des patients était de 40,2 ans (± 18,7) et ils avaient en moyenne 11,5 années (± 3,6) d’instruction. La plupart des patients avaient une lesion frontale (57,6%) ou temporale (40%). Soixante-deux pour cent ont eu une amnésie post-traumatique de moins de 24 heures. Soixantedix pour cent avaient subi un traumatisme crânien léger, 14% un traumatisme modéré et 15% un traumatisme sévère. Les déficits cognitifs les plus fréquemment observés selon le NRS étaient ceux de l’attention, de la mémoire et de la flexibilité mentale ainsi qu’un ralentissement psychomoteur et de la fatigabilité. La plupart des patients ont eu un bon rendement avec des scores de 2 et 3 au GOS. Quarante-cinq pour cent des patients sont retournés à la maison après leur congé de l’hôpital, 51,7% ont été référés en réadaptation (interne ou externe) et 3,2% ont été transférés dans un centre de soins de longue durée.

Conclusion:

Comme le mandat des centres de soins actifs est spécifique, les caractéristiques de notre série de TCs pourraient aider à la prise de décision et à la planification des soins et des services offerts à cette population.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 2 , May 2005 , pp. 186 - 193
Copyright
Copyright © The Canadian Journal of Neurological 2005

References

1. Graham, DI, Gennarelli, TA. Trauma. In: Graham, DI, Lantos, PL,(Eds). Greenfield’s Neuropathology. 6th ed., 1997; 197–262.Google ScholarPubMed
2. Riley, E. La régionnalisation des services de réadaptationtraumatologique: Travail d’analyse et de réflexion. Rapport, Direction générale des programmes. Ministère de la santé et des services sociaux. 1999; 1–91 Google Scholar
3. Khan, S, Khan, A, Feyz, M. Decreased length of stay, cost savings anddescriptive findings of enhanced patient care resulting from an integrated traumatic brain injured programme. Brain Inj 2002; 16: 537–554.Google Scholar
4. Katz, DI, Alexander, MP. Predicting course of recovery and outcome for patients admitted to rehabilitation. Arch Neurol 1994; 51: 661–670.CrossRefGoogle ScholarPubMed
5. Levin, HS, High, WM, Goethe, KE, et al. The neurobehavioral ratingscale assessment of the behavioural sequelea of head injury by the clinicians. J Neurol Neurosurg Psychiatry 1987; 50: 183–193.Google Scholar
6. Levin, HS, Gary, HE, Eisenberg, HM, et al. Neurobehavioral outcome 1 year after severe head injury. J Neurosurg 1990; 73: 699–709.CrossRefGoogle ScholarPubMed
7. Asikainen, I, Kaste, M, Sarna, S. Predicting late outcome for patientswith traumatic brain injury referred to a rehabilitation programme: a study of 508 Finnish patients 5 years or more after injury. Brain Inj 1998; 12: 95–107.CrossRefGoogle ScholarPubMed
8. Caillé, S, De Guise, E, Feyz, M, Hardy, P, Richard, S. Early prediction ofneuropsychological deficits and global outcome during the acute phase of treatment following traumatic brain injury. Brain Cogn 2000; 44: 1:30–34.CrossRefGoogle Scholar
9. Dikmen, S, Temkin, N, McLean, A, et al. Memory and head injuryseverity. J Neurol Neurosurg Psychiatry 1987; 50: 1613–1618.Google Scholar
10. Gentilini, M, Nichelli, P, Schoenhuber, R, et al. Neuropsychological evaluation of mild head injury. J Neurol Neurosurg Psychiatry 1985; 48: 137–140.Google Scholar
11. Levin, HS, Mattis, S, Ruff, RM, et al. Neurobehavioral outcomefollowing minor head injury: a three-centre study. J Neurosurg 1987; 66: 234–243.Google Scholar
12. Ruff, RM, Young, D, Gautille, T, et al. Verbal learning deficits following severe head injury: heterogeneity in recovery over 1 year. J Neurosurg 1991; 75: S50–S58.CrossRefGoogle Scholar
13. Wilson, B. Recovery and compensatory strategies in head injuredmemory impaired people several years after insult. J Neurol Neurosurg Psychiatry 1992; 55: 177–180.Google Scholar
14. Gervais, M, Dubé, S. Étude exploratoire des besoins en servicesofferts à la clientèle traumatisée cranio- cérébrale. Publication de l’Université Laval, 1999.Google Scholar
15. Levin, H, O’Donnell, V, Grossman, R. The Galveston Orientation andAmnesia test. J Nerv Ment Dis 1979; 167: 675–684.Google Scholar
16. Teasdale, G, Jennett, B. Assessment and prognosis of coma after headinjury. Acta Neurochir 1976; 34: 45–55.CrossRefGoogle Scholar
17. Rimel, R. Giordani, B, Barth, JT, et al. Moderate head injury:completing the clinical spectrum of brain injury. Neurosurg 1982; 11: 344–351.Google Scholar
18. Research Foundation-State University of New York. Guide for useof the uniform set for medical rehabilitation including the functional independence measure (FIM). State University of New York at Buffalo. Department of Rehabilitation Medicine. 1990.Google Scholar
19. Jennett, B, Snoek, J, Bond, MR, Brooks, N. Disability after severehead injury: Observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry 1981; 44: 285–293.Google Scholar
20. Bombardier, CH, Thurber, CA. Blood alcohol level and earlycognitive status after traumatic brain injury. Brain Inj 1998; 12: 725–734.Google Scholar
21. Solomon, D, Malloy, P. Alcohol, head injury and neuropsychological function. Neuropsychol Rev 1992; 3: 249–280.Google Scholar
22. Kelly, MP, Johnson, CTR, Knoller, N, Drubach, DA, Winslow, MM. Substance abuse, traumatic brain injury and neuropsychological outcome. Brain Inj 1997; 11: 391–402.Google Scholar
23. Long, CJ, William, JM. Neuropsychological assessment and treatment of head trauma patients. In: Whitaker, HA (Ed). Neuropsychological Studies of Nonfocal Brain Damage. New York: Springer-Verlag, 1988; 132–161 Google Scholar
24. Parkinson, D, Stephensen, S, Phillips, S. Head injuries: a prospective,computerized study. Can J Surg 1985; 28: 79–82.Google ScholarPubMed
25. Alves, WM, Jane, JA. Mild traumatic brain injury: damage andoutcome. In: Beck, DP, Povlishock, JT (Eds). Central Nervous System Trauma Status Report. Washington DC: National Institute of Health, 1985; 255–270 Google Scholar
26. Berrol, S. Moderate head injury. In: Bach y Riota, P (Ed). Traumatic Brain Injury. New York: Demos, 1989; 31–40 Google Scholar
27. Kraus, JF, Black, MA, Hessol, N, et al. The incidence of acute braininjury and serious impairment in a defined population. Am J Epidemiol 1984; 119: 186–201.Google Scholar
28. Russel, WR, Smith, A. Post-traumatic amnesia in closed head injury. Arch Neurol 1961; 5: 4–17.Google Scholar
29. Alexander, MP. Mild traumatic brain injury: Pathophysiology,natural history, and clinical management. Neurology 1995; 45: 1253–1260.Google Scholar
30. Williams, DH, Levin, HS, Eisenberg, HM. Mild head injury classification. Neurosurgery 1990; 27(3): 422–428.Google Scholar
31. Esselman, PC, Uomoto, JM. Classification of the spectrum of mildtraumatic brain injury. Brain Injury 1995; 9(4): 417–424.Google Scholar
32. King, NS. Emotional, neuropsychological, and organic factors: theiruse in the prediction of persisting postconcussion symptoms after moderate and mild head injuries. J Neurol Neurosurg Psychiatry 1996; 61: 75–81.Google Scholar
33. Culotta, VP, Sementilli, ME, Gerold, K, et al. Clinicopathological heterogeneity in the classification of mild head injury. Neurosurg 1996; 38(2): 245–250.Google Scholar
34. Blostein, PA, Jones, SJ, Buechler, CM, Vandongen, S. Cognitivescreening in mild traumatic brain injuries: analysis of the neurobehavioral cognitive status examination when utilized during initial trauma hospitalization. J Neurotrauma 1997; 14: 171–177.Google Scholar
35. Mazaux, JM, Masson, F, Levin, H, et al. Long-termneuropsychological outcome and loss of social autonomy after traumatic brain injury. Arch Phys Med Rehabil 1997; 78: 1316–1320.Google Scholar
36. Milner, B. Psychological aspects of focal epilepsy and its neurological management. In: Purpura, DP, Penry, JK, Walter, LD, (Eds). Advance In Neurology (Vol. 8). New York: Raven Press, 1975; 299–321 Google Scholar
37. Stuss, DT, Benson, DF. Neuropsychological studies of the frontallobes. Psychol Bull 1984; 95: 3–28.Google Scholar
38. Ruff, RM, Crouch, JA, Troster, AI, et al. Selected cases of pooroutcome following a minor brain trauma: comparing neuropsychological and positron emission tomography assessment. Brain Inj 1994: 8: 297–308.Google Scholar
39. Pierallini, A, Pantano, P, Fantozzi, LM, et al. Correlation between MRI findings and long-term outcome in patients with severe brain trauma. Neuroradiology 2000; 42: 860–867.Google Scholar
40. Azouvi, P. Neuroimaging correlates of cognitive and functionaloutcome after traumatic brain injury. Curr Opin Neurol 2000; 13: 665–669.Google Scholar
41. Medical Disability Society. The management of traumatic brain injury. London: The Medical Disability Society, 1988.Google Scholar