Romanian Neurosurgery (Mar 2007)
The clinical expertise of the emergency hospital "Bagdasar - Arseni" in the complex rehabilitation of post-traumatic brain injury patients
Abstract
Objective. To systematically evaluate the outcomes we obtained in the complex rehabilitation of post-traumatic brain injury (TBI) patients compared to similar approaches. Material and methods. This study is a retrospective statistical analysis on a series of 333 post-TBI patients - 245 males and 88 females - with the mean age around 40 years, most of them married, transferred to our PRM clinic division, during 2001-2005. To assess the motor-functional/ independence status and its evolution / outcomes, at admission and at discharge, we used a simplified by us, mixture (from seven to four levels, respectively, from six to four grades), of the FIM instrument (by the State University of New York at Buffalo / UBFA, 2007) and of the modified Rankin, scales. For assessing speech disorders, at admission and at discharge, the aphasia classification we used, comprised (also) four levels: from very severe (global), to mild (moderate anomic and respectively, disarthria). The psychological aspects were recorded in two moments: the initial evaluation (45 patients-at their discharge) and the final one (30 patients-after one year), using: MMSE, Hamburg-Wechsler Intelligence Scale, Cattell Anxiety Questionnaire, SF-8TM and respectively, the "Behavior and Mood Evaluative" Scale. All the collected data were processed with the Statistical Package for Social Sciences (SPSS10.0): descriptive, correlative, differential/inferential. Results and discussions. The main causes of TBI were: car accidents = 194 cases (58.2%), falls from height = 63 cases (18.9%), aggressions = 44 cases (13.2%), other causes = 32 patients (9.6%). Regarding the motor-functional/ independence outcome status, the statistical analysis showed that this correlated with the at admission levels: the better the initial state, the better the final one. As for speech disorders, 121 (36.3%) patients presented aphasia; at discharge, 117 (96.7% of them were ameliorated (in very large variable amounts, ranging from 25% to 8000%) and 4 (3.3%) were stationary. Concerning family re-integration, 270 (81%) of our patients were completely re-integrated in their families environment, 15% only partially and almost 4% were no longer accepted by their families. As for the professional re-insertion, farmers/peasants (65.8%) and respectively, college students & pupils (8-18 years old: 65.2%), achieved the highest levels of occupational re-integration, in contrast with graduated employees, followed by undergraduates, who showed the smallest amount of professional re-insertion: 79% and respectively, 52% of them, retired / quit high schools because of their post-TBI sequels. Towards the global perception on their quality of life (QOL), our patients displayed an improving trend during the first year after TBI, from - initially - a negative perception, to a positive one: finally, 97% appreciated they were satisfied with their (late) post-TBI lives. Conclusions. Our results - including especially the rehabilitation outcomes - are quite similar to those obtained and published by other rehabilitation centers, worldwide. As confirmed at the 4 International Conference of Academia Multidisciplinaria Neurotraumatologica (AMN - Copenhagen, 2006), the 333 patients we studied represent, to date, the largest post-TBI case series, internationally.
