Article

OBJECTIVE: To assess: (i) the clinical characteristics and injury descriptors of
patients with severe traumatic brain injury in Northern Sweden admitted to the
single Neurotrauma Center (NC) serving this region; (ii) the care pathway of
patients from injury to 3 months after discharge from the NC ;
and (iii) the
outcomes at 3 months post-injury. DESIGN: Population-based prospective 2-year
cohort study. PATIENTS: Patients age 17-65 years with acute severe traumatic
brain injury, lowest non-sedated Glasgow Coma Scale (GCS) score of 3-8 within 24
h post-trauma. METHODS: Patients were treated according to an intracranial
pressure-oriented protocol based on the Lund concept at the NC. They were
assessed at 3 weeks after injury with Rancho Los Amigos Cognitive Scale Revised
(RLAS-R), Levels of Cognitive functioning, and at 3 months with RLAS-R and
Glasgow Outcome Scale Extended (GOSE). RESULTS: A total of 37 patients were
included. Hospital deaths within 3 months post-injury occurred in 5 patients.
After 3 months the RLAS-R scores were significantly improved (< 0.001). Eight
patients had both "superior cognitive functioning" on the RLAS-R and "favourable
outcome" on the GOSE. Thirty-four patients (92%) were directly admitted to the
NC. By contrast, after discharge patients were transferred back to one of several
county hospitals or to one of several local hospitals, and some had multiple
transfers between different hospitals and departments. CONCLUSION: Overall
outcomes were surprisingly good in this group of severely injured patients. The
routines for transferring patients with severe traumatic brain injury from a
geographically large, sparsely populated region to a regional NC to receive
well-monitored neurosurgical care seem to work very well. The post-acute clinical
pathways are less clearly reflecting an optimized medical and rehabilitative
strategy.

Langue : ANGLAIS