TraumaOutcome following moderate traumatic brain injury
Section snippets
Methods
A prospective database was compiled for all patients admitted to the University of Louisville Hospital, Louisville, Kentucky, with moderate closed head injury (GCS 9-12) between October 1995 and March 1998. Information regarding patient demographics, associated injuries, length of stay (LOS), and complications were collected. All patients were treated following criteria developed as part of our moderate TBI clinical pathway (Figure 1). This pathway was developed at our institution to
Outcome at time of hospital discharge
Seventy-nine consecutive patients with moderate TBI were included in this study. No deaths occurred during the acute in-patient hospitalization. The average age at the time of injury was 37.8 (±17.2) years with a median 24-hour GCS of 10 (Figure 2). Pneumonia occurred in 33% of the patients. The average (range; SD) length of hospital and ICU stay and the number of ventilator days were 15.8 (4–58; ±9.9), 9.1 (2–36; ±6.6), and 5.5 (0–31; ±4.4) days, respectively.
At the time of discharge 67% had
Discussion
The short-term outcome following moderate closed head injury is quite unpredictable. In our group of 79 patients, the average length of acute hospital stay was 15.8 days. These patients experienced progressive neurologic improvement throughout their hospital stay as evidenced by their increase in GCS. The use of the clinical pathway helped to provide patients with the highest standard of care and facilitated communication between the numerous health care providers. This pathway also ensured
Conclusion
Following moderate closed head injury most patients experienced significant neurologic improvement. Age ≥45 years, development of pneumonia, and delay in enteral feeding have all been shown to prolong the length of hospital stay. In addition, the subjective, cognitive, emotional, and functional deficits following this type of injury can be quite extensive and prolonged. Physicians should be aware of these long-term sequela so they can provide the appropriate support and treatment to patients
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