Associations Between Care Pathways and Outcome 1 Year After Severe Traumatic Brain Injury

Godbolt, Alison K.; Stenberg, Maud; Lindgren, Marie; Ulfarsson, Trandur; Lannsjö, Marianne; Stålnacke, Britt-Marie; Borg, Jörgen; DeBoussard, Catharina Nygren

doi:10.1097/htr.0000000000000050

Cited by 30 publications

(29 citation statements)

References 19 publications

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“…In a previous study, 2 we found that, having controlled for acute prognostic variables known to impact on outcome, length of stay in intensive care, time between intensive care and rehabilitation admission, and the presence of any medical complication 3 weeks after injury were all associated with unfavourable outcome 1 year after injury. In this study, we explore further rates of specific complications and associations of these with outcome at 1 year.…”

Section: Introductionmentioning

confidence: 80%

“…This study formed part of a prospective, multicentre, observational study of patients who had sustained severe TBI (the ‘PROBRAIN’ study 2 ).…”

Section: Methodsmentioning

confidence: 99%

“…Total length of hospital stay can vary from weeks to several months. 2 Some patients with severe TBI recover relatively well and in the long term return to work, 3 while for others support at home or continuing institutional care may be necessary.…”

Section: Introductionmentioning

confidence: 99%

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Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

et al. 2015

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BackgroundMedical complications after severe traumatic brain injury (S-TBI) may delay or prevent transfer to rehabilitation units and impact on long-term outcome.ObjectiveMapping of medical complications in the subacute period after S-TBI and the impact of these complications on 1-year outcome to inform healthcare planning and discussion of prognosis with relatives.SettingProspective multicentre observational study. Recruitment from 6 neurosurgical centres in Sweden and Iceland.Participants and assessmentsPatients aged 18–65 years with S-TBI and acute Glasgow Coma Scale 3–8, who were admitted to neurointensive care. Assessment of medical complications 3 weeks and 3 months after injury. Follow-up to 1 year. 114 patients recruited with follow-up at 1 year as follows: 100 assessed, 7 dead and 7 dropped out.Outcome measureGlasgow Outcome Scale Extended.Results68 patients had ≥1 complication 3 weeks after injury. 3 weeks after injury, factors associated with unfavourable outcome at 1 year were: tracheostomy, assisted ventilation, on-going infection, epilepsy and nutrition via nasogastric tube or percutaneous endoscopic gastroscopy (PEG) tube (univariate logistic regression analyses). Multivariate analysis demonstrated that tracheostomy and epilepsy retained significance even after incorporating acute injury severity into the model. 3 months after injury, factors associated with unfavourable outcome were tracheostomy and heterotopic ossification (Fisher's test), infection, hydrocephalus, autonomic instability, PEG feeding and weight loss (univariate logistic regression). PEG feeding and weight loss at 3 months were retained in a multivariate model.ConclusionsSubacute complications occurred in two-thirds of patients. Presence of a tracheostomy or epilepsy at 3 weeks, and of PEG feeding and weight loss at 3 months, had robust associations with unfavourable outcome that were incompletely explained by acute injury severity.

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Section: Introductionmentioning

confidence: 80%

“…This study formed part of a prospective, multicentre, observational study of patients who had sustained severe TBI (the ‘PROBRAIN’ study 2 ).…”

Section: Methodsmentioning

confidence: 99%

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Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

et al. 2015

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“…12 Several variables that capture the patient's status upon admission to rehabilitation appear to be a proxy for the severity of the index injury and hold considerable predictive power for rehabilitation outcomes (e.g., time from injury to rehabilitation admission, functional independence at admission, presence of agitation or other pathognomonic signs). 2,10,11 …”

mentioning

confidence: 99%

Effects of Patient Preinjury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury

Corrigan

Horn

Barrett

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Objective To examine associations of patient and injury characteristics with outcomes at inpatient rehabilitation discharge and 9 months post-discharge for patients with traumatic brain injury (TBI) Design Prospective, longitudinal observational study Setting 10 inpatient rehabilitation centers (9 US, 1 Canada) Participants Consecutive patients (n=2130) enrolled between 2008 and 2011, admitted for inpatient rehabilitation after index TBI injury, and divided into 5 subgroups based on rehabilitation admission FIM Cognitive score Interventions Not applicable Main Outcome Measures Rehabilitation length of stay, discharge to home, and FIM at discharge and 9 months post-discharge. Results Severity indices increased explained variation in outcomes beyond that accounted for by patient characteristics. FIM Motor scores were generally the most predictable. Higher functioning subgroups had more predictable outcomes then subgroups with lower cognitive function at admission. Age at injury, time from injury to rehabilitation admission, and functional independence at rehabilitation admission were the most consistent predictors across all outcomes and subgroups. Conclusions Findings from previous studies of the relationships among patient and injury characteristics and rehabilitation outcomes were largely replicated. Discharge outcomes were most strongly associated with injury severity characteristics; while predictors of functional independence at 9 months post-discharge included both patient and injury characteristics.

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“…[16][17][18] Study design has been described previously. 16,17 In brief, inclusion criteria were severe, non-penetrating, traumatic brain injury requiring neurointensive care, with acute Glasgow Coma Scale score of [3][4][5][6][7][8]19 in adult patients aged 18-65 years. Exclusion criteria were death or expected death within 3 weeks of injury.…”

Section: Methodsmentioning

confidence: 99%

Behavioural problems in the first year after Severe traumatic brain injury: a prospective multicentre study

et al. 2016

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Objective: To investigate the occurrence of behavioural problems in patients with severe traumatic brain injury during the first year after injury and potential associations with outcome. An additional post hoc objective was to analyse the frequency of behaviours with need for intervention from staff. Design and setting: In a prospective population based cohort study 114 patients with severe traumatic brain injury were assessed at three weeks, three months and one year after injury. Main measures: Assessments included clinical examination and standardised instruments. Agitation was assessed with the Agitated Behaviour Scale, the course of recovery by the Rancho Los Amigo Scale and outcome by Glasgow Outcome Scale Extended. Results: Agitation were most common at 3 weeks post injury and 28% (n=68) of the patients showed at least one agitated behaviour requiring intervention from staff. Presence of significant agitation at 3 weeks after injury was not associated with poor outcome. At 3 months agitation was present in 11% (n=90) and apathy in 26 out of 81 assessed patients. At 3 months agitation and apathy were associated with poor outcome at one year. Conclusions: Most agitated behaviours in the early phase are transient and are not associated with poor outcome. Agitation and apathy are uncommon at three months but when present are associated with poor outcome at one year after injury. In the early phase after a severe traumatic brain injury agitated behaviour in need of interventions from staff occur in a substantial proportion of patients.

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Associations Between Care Pathways and Outcome 1 Year After Severe Traumatic Brain Injury

Abstract: Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.

Cited by 30 publications

References 19 publications

Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome

Effects of Patient Preinjury and Injury Characteristics on Acute Rehabilitation Outcomes for Traumatic Brain Injury

Behavioural problems in the first year after Severe traumatic brain injury: a prospective multicentre study

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