Outcome following moderate traumatic brain injury

doi:10.1016/S0090-3019(03)00378-1

Surgical Neurology

Volume 60, Issue 4, October 2003, Pages 285-291

https://doi.org/10.1016/S0090-3019(03)00378-1 Get rights and content

Abstract

Background

Little is known about the outcome following moderate traumatic brain injury (TBI) (GCS 9-12). Most patients regain consciousness; however, the full magnitude of long-term cognitive and functional deficits is unknown.

Methods

We conducted a prospective observational study evaluating the outcome of patients suffering moderate TBI between October 1995 and March 1998. Long-term outcome was assessed by telephone interviews.

Results

A total of 79 consecutive patients were included. Average length of ICU and total hospital stay was 9.1 and 15.8 days respectively. The median GCS at 24 hours was 10 with 67% improving to GCS 15 by time of discharge. The presence of multisystem trauma did not affect outcome; however, age ≥45, initiation of enteral feeding after postinjury day 4 and the presence of pneumonia were all associated with longer lengths of stay and increased complication rates.

Fifty-six (71%) patients were contacted for follow-up at an average of 27.5 months. GOS scores were 5 in 44%, 4 in 41%, 3 in 9%, 1 in 6%. Seventy-four percent of patients employed premorbidly returned to full-time work. Questions regarding cognitive and functional status revealed significant problems in the majority of patients.

Conclusions

Pneumonia, age ≥45 years and a delay in initiation of enteral feeding all increased the duration of acute care hospital stay following moderate TBI. In addition, cognitive, emotional, and functional problems following such injuries are extensive and long lasting. Physicians must be knowledgeable of these long-term sequela so they can provide the appropriate support and treatment to these patients.

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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TraumaOutcome following moderate traumatic brain injury

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Outcome at time of hospital discharge

Discussion

Conclusion

Lancet

Reduced use of resources by early tracheostomy in ventilator-dependant patients with blunt trauma

Surgery

Critical path educationnecessary components and effective strategies

J Cont Edu Nurs

Enteral versus parenteral nutrition following severe closed head injury

J Trauma

Tracheostomy and percutaneous endoscopic gastrostomy in the management of the head-injured patient

Am Surg

Spine updateclinical pathways

Spine

Trauma
Outcome following moderate traumatic brain injury