Українська Інтервенційна Нейрорадіологія та Хірургія (Feb 2024)
Multidisciplinary approach to the treatment of traumatic brain injury in children and rehabilitation
Abstract
Оbjective ‒ to show the need for a comprehensive approach to the treatment and rehabilitation of patients with traumatic brain injury (TBI); the specifics of psychosomatic and psychophysiological complications in children as a result of trauma. Materials and methods. In period from 2019 to 2024 in the National Children's Specialized Hospital Okhmatdyt was applied a multidisciplinary approach in the treatment of TBI in 112 patients (children from 9 months to 16 years, the main group). In 22 (19.7 %) cases had isolated TBI and in 90 (80.3 %) had polytrauma. The peculiarity of treating children in the period 2022‒2024 is the presence of injuries as a result of hostilities. The mental state was assessed at the time of discharge and 3 months later using the State-Trait Anxiety Inventory (STAI) and the Kerdo index, and the Ronde index was used also. The control group was formed from 115 children who were treated until 2019, comparable in terms of age, type of injuries, length of stay in the hospital with patients of the main group. Results. The main complications in the psychoemotional, cognitive, psychosomatic, psychophysiological spheres are presented. The main general approaches in the treatment of brain injury and its consequences regarding the basic communicative work of a multidisciplinary team are shown: anesthesiologist, neurosurgeon, trauma surgeon, general surgeon, psychologist, neurologist, radiologist, doctor of functional diagnostics, rehabilitator. The features of anesthesiologist's work during sedation and anesthesia are described. A comparative assessment of the patient’s condition at discharge under 2019 (without of the principle of a multidisciplinary approach using) and in children who were treated with this method was performed. The dynamics of the various complications types presence in patients before 2019 and after was showed (with or without the multidisciplinary approach in treatment). Conclusions. A multidisciplinary approach to the treatment of both isolated TBI and polytrauma ensures timely diagnosis of psychological, psychosomatic, and psychophysiological disorders, and allows the involvement of appropriate specialists who carry out correction and rehabilitation. All this improves the quality of treatment and reduces the frequency of complications. Specialists who provide assistance to children with trauma should know the age-based foundations of child psychology in order to timely involve a psychologist in diagnosis and treatment at the stages of traumatic injury. Communication in the work between specialists makes it possible to pay attention to the peculiarities of the traumatic process, the complications that arise and to carry out correction and necessary rehabilitation in a timely manner. The most pronounced psychological and psychophysical complications in the main group were among children who suffered as a result of military actions and cruel treatment. Three months after receiving the injury, asthenic syndrome remained in 29.5 % of patients of the main group, 24.5 % of patients of the control group. In the control group, there is a decrease in these symptoms, but to a lesser extent, it can be interpreted so that the psychologist's recommendations were not taken into account by the neurosurgeon (surgeon) and the psychologist was not always involved in the treatment process, or some recommendations were not followed by the parents at the outpatient stage after discharge.
