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A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years

Journal article
Authors Emma Andersson
Dovile Rackauskaite
Elisabeth Svanberg
Ludvig Z Csajbok
Martin Öst
Bengt Nellgård
Published in Acta Anaesthesiologica Scandinavica
Volume 61
Issue 5
Pages 502-512
ISSN 0001-5172
Publication year 2017
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 502-512
Language en
Links dx.doi.org/10.1111/aas.12880
Keywords SEVERE HEAD-INJURY, LUND CONCEPT, FOLLOW-UP, SCALE, DISABILITY, FATIGUE, REHABILITATION, PRINCIPLES, MANAGEMENT, MORTALITY, Anesthesiology
Subject categories Anaesthetics

Abstract

Background: Severe traumatic brain injury (sTBI) can be divided into primary and secondary injuries. Intensive care protocols focus on preventing secondary injuries. This prospective cohort study was initiated to investigate outcome, including mortality, in patients treated according to the Lund Concept after a sTBI covering 10-15 years post-trauma. Methods: Patients were included during 2000-2004 when admitted to the neurointensive care unit, Sahlgrenska University Hospital. Inclusion criteria were: Glasgow coma scale score of 8, need for artificial ventilation and intracranial monitoring. Glasgow Outcome Scale (GOS) was used to evaluate outcome both at 1-year and 10-15 years post-trauma. Results: Ninety-five patients, (27 female and 68 male), were initially included. Both improvement and deterioration were noted between 1- and 10-15 years post-injury. Mortality rate (34/95) was higher in the studied population vs. a matched Swedish population, (Standard mortality rate (SMR) 9.5; P < 0.0001). When dividing the cohort into Good (GOS 4-5) and Poor (GOS 2-3) outcome at 1-year, only patients with Poor outcome had a higher mortality rate than the matched population (SMR 7.3; P < 0.0001). Further, good outcome (high GOS) at 1-year was associated with high GOS 10-15 years post-trauma (P < 0.0001). Finally, a majority of patients demonstrated symptoms of mental fatigue. Conclusion: This indicates that patients with severe traumatic brain injury with Good outcome at 1-year have similar survival probability as a matched Swedish population and that high Glasgow outcome scale at 1-year is related to good long-term outcome. Our results further emphasise the advantage of the Lund concept.

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