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- Godbolt, Alison K., et al.
(author)
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Disorders of consciousness after severe traumatic brain injury : a Swedish-Icelandic study of incidence, outcomes and implications for optimizing care pathways
- 2013
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In: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 45:8, s. 741-748
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Journal article (peer-reviewed)abstract
- Background: Very severe traumatic brain injury may cause disorders of consciousness in the form of coma, unresponsive wakefulness syndrome (also known as vegetative state) or minimally conscious state. Previous studies of outcome for these patients largely pre-date the 2002 definition of minimally conscious state. Objectives: To establish the numbers of patients with disorder of consciousness at 3 weeks, 3 months and 1 year after severe traumatic brain injury, and to relate conscious state 3 weeks after injury to outcomes at 1 year. Design: Multi-centre, prospective, observational study of severe traumatic brain injury. Inclusion criteria: lowest (non-sedated) Glasgow Coma Scale 3-8 during the first 24 h; requirement for neurosurgical intensive care; age 18-65 years; alive 3 weeks after injury. Diagnosis of coma, unresponsive wakefulness syndrome, minimally conscious state or emerged from minimally conscious state was based on clinical and Coma Recovery Scale Revised assessments 3 weeks, 3 months and 1 year after injury. One-year outcome was measured with Glasgow Outcome Scale Extended (GOSE). Results: A total of 103 patients was included in the study. Of these, 81% were followed up to 1 year (76% alive, 5% dead). Three weeks after injury 36 were in coma, unresponsive wakefulness syndrome or minimally conscious state and 11 were anaesthetized. Numbers of patients who had emerged from minimally conscious state 1 year after injury, according to status at 3 weeks were: coma (0/6), unresponsive wakefulness syndrome (9/17), minimally conscious state (13/13), anaesthetized (9/11). Outcome at 1 year was good (GOSE>4) for half of patients in minimally conscious state or anaesthetized at 3 weeks, but for none of the patients in coma or unresponsive wakefulness syndrome. These differences in outcome were not revealed by prognostic predictions based on acute data. Conclusion: Patients in minimally conscious state or anaesthetized 3 weeks after injury have a better prognosis than patients in coma or unresponsive wakefulness syndrome, which could not be explained by acute prognostic models.
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- Matuseviciene, Giedre, et al.
(author)
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Early intervention for patients at risk for persisting disability after mild traumatic brain injury : A randomized, controlled study
- 2013
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In: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 27:3, s. 318-324
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Journal article (peer-reviewed)abstract
- Study objective: To investigate the effect of an early intervention visit in addition to written information and treatment as usual for patients with an estimated high risk for persisting disability after a mild traumatic brain injury (MTBI). Research design: Randomized controlled trial. Methods: One hundred and seventy-three patients, aged 15-70 years with a Glasgow Coma Scale of 14-15 were included. All received written information about MTBI. Ninety-seven patients who reported three or more symptoms according to the Rivermead Post-Concussion Symptoms Questionnaire (RPQ) at 10 days after the injury were considered as high-risk patients and were randomized to either early visit to a doctor or to treatment as usual (TAU); all patients including the 76 low-risk patients were followed-up at 3 months. Completion rate was 83%. Outcome measures included RPQ and the Hospital Anxiety and Depression Scale. Results: RPQ symptoms decreased significantly in both randomized groups, but were not significantly different in the groups at 3 months. At 3 months, anxiety and depression scores did not differ between groups. Conclusions: An early intervention, offered to patients with an estimated high risk for persisting disability, had no additional effect on symptom level at 3 months after MTBI as compared to TAU.
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- Rosén, Thord, et al.
(author)
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Traumatisk hjärnskada kan ge hypofyssvikt : Förslag till riktlinjer för utvärdering av hypofysfunktionen
- 2012
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In: Läkartidningen. - : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 109:12, s. 629-632
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Journal article (other academic/artistic)abstract
- Traumatisk hjärnskada (traumatic brain injury, TBI) är en av de vanligaste orsakerna till död och nedsatt funktion hos människor i arbetsför ålder. Patienter som överlever svåra skallskador utgör en växande patientkategori inom dagens sjukvård. På senare år har det aktualiserats att allvarligt skalltrauma kan ge skador i hypofys–hypotalamusregionen. Det är angeläget att dessa patienter utreds för eventuell hypofyssvikt så att hormonell substitutionsterapi kan inledas om endokrin insufficiens fastställs. Detta kan förhoppningsvis underlätta efterföljande rehabilitering och därmed förbättra prognosen. Vi presenterar här ett förslag till riktlinjer för utvärdering av hypofysfunktionen hos TBI-patienter. Samtidigt vill vi informera en bredare läsekrets om TBI-begreppet.
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- Ulfarsson, Trandur, 1967, et al.
(author)
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A history of unemployment or sick leave influences long-term functioning and health-related quality-of-life after severe traumatic brain injury
- 2014
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In: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 28:3, s. 328-335
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Journal article (peer-reviewed)abstract
- Primary objective: The consequences of pre-morbid factors in adults with severe traumatic brain injury have not been widely addressed. This study aimed to determine whether being unemployed or on sick leave before injury influences long-term health-related quality-of-life (HRQoL) and functioning in patients with severe traumatic brain injury. Subjects: Fifty-one consecutive patients were studied; aged 16-65 years, with severe traumatic brain injury who were admitted to Sahlgrenska University Hospital, Gothenburg, from 1999-2002. Methods: The patients were assessed once, 2-11 years after trauma. Data from the time of injury were combined into a validated prognostic model to adjust for injury severity. Data on sick leave and unemployment before injury were gathered from the Swedish social insurance agency. Outcomes were measured with the Short Form-36 Health Survey, the Glasgow Outcome Scale-Extended, and a self-report questionnaire specifically designed for this study to measure functioning. Results: In a multivariate analysis, a history of sick leave/unemployment predicted a worse long-term global outcome, more problems with personal activities of daily living and worse HRQoL. Conclusion: These results should be considered when refining outcome predictions and optimizing rehabilitation interventions for patients with severe traumatic brain injury.
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- Ulfarsson, Trandur, 1967, et al.
(author)
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Pituitary Function and Functional Outcome in Adults after Severe Traumatic Brain Injury: The Long-Term Perspective.
- 2013
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In: Journal of neurotrauma. - : Mary Ann Liebert Inc. - 1557-9042 .- 0897-7151. ; 30:4, s. 271-280
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Journal article (peer-reviewed)abstract
- Posttraumatic hypopituitarism (PTHP) has been linked to disability and decreased quality of life. However, no studies have addressed the long-term consequences of PTHP in adults with severe traumatic brain injury (TBI) only. In this study, we evaluated the relationship between pituitary function, quality of life, and functioning in 51 patients (age 16-65 years) with severe TBI who were admitted to Sahlgrenska University Hospital, Gothenburg from 1999 to 2002. The patients were assessed once, 2-10 years after trauma. Data from the time of injury were collected retrospectively to adjust for injury severity. Outcome measures included hormonal testing, the Short Form-36 Health Survey, the Glasgow Outcome Scale-Extended, and a self-report questionnaire specifically designed for this study and based on the International Classification of Functioning, Disability and Health. Of 51 patients, 14 (27.5%) presented with PTHP, and 11 (21.6%) had isolated growth hormone deficiency. Patients with PTHP were more often overweight at follow-up (p = 0.01); the higher body mass index was partially explained by PTHP (R2 change = 0.07, p = 0.001). Otherwise no significant correlation was found between PTHP, functioning, or patient-reported quality of life. This study-which is unique in the homogeneity of the patients, the long follow-up time, and the use of injury severity as an outcome predictor-did not confirm results from previous studies linking PTHP to a worse outcome. Thus, screening for PTHP might be restricted to specific subgroups such as overweight patients, indicating growth hormone deficiency.
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