Neurorehabilitation Following Craniocerebral Trauma

• Published in: European journal of trauma Vol. 31; no. 4; pp. 344 - 358
• Main Author: von Wild, Klaus R. H.
• Format: Journal Article
• Language: English
• Published: Munich Springer Nature B.V 01.08.2005
• Subjects: Brain damage; Clinical outcomes; Quality of life; Rehabilitation
• ISSN: 1439-0590; 1863-9933; 1615-3146; 1863-9941
• DOI: 10.1007/s00068-005-2059-z

Purpose: To review the quality management of functional neurorehabilitation in patients after craniocerebral trauma with an emphasis on factors that may explain variability of early and late outcomes after 1 year and how this might be influenced to improve health-related quality of life after traumatic brain injury (TBI). Methods: First ever prospective controlled, population- based, multicenter study on epidemiology of acute craniocerebral injuries (CCI) in Germany and analysis of acute medical care and functional rehabilitation with early and 1-year outcome. Catchment areas Hanover and Muenster (sum of inhabitants 2.114 million). The definition of acute CCI was according to the ICD-10: S-02, S-04, S-06, S-07, S-09 in combination with dizziness or vomiting, retrograde or anterograde amnesia, impaired consciousness, skull fracture, and/or focal neurologic impairment. Results: 6,783 CCI patients (58% male) were admitted for emergency hospital treatment. 28% patients were < 1 to 15 years, 18% > 65 years of age. Completed questionnaires of 63.5% of the patients were analyzed. 1-year follow-up of two thirds of acute CCI. Incidence was 321/100,000. Initial CCI severity (Glasgow Coma Scale [GCS]) of 55% of patients showed 90.9% mild, 3.9% moderate, and 5.2% severe TBI. 5,221 patients (77%) were hospitalized, 1.4% of them died. Follow-up of 63.5%. Only 258 patients (3.8%) received neurologic-neurosurgical rehabilitation (73% male), 68% within 1 month after injury, 5% were < 16 years, 25% > 65 years of age. Early rehabilitation of 100 patients (39%), one fifth referred within first week. Outcome end of early rehabilitation phase "B": Glasgow Outcome Scale (GOS) 1 = 4%; GOS 2 = 2.7%, GOS 3 = 37.3%, GOS 4 = 26.7%, GOS 5 = 29.3%, and end of rehabilitation "B-E": GOS 1 = 1.2%, GOS 2 = 1.7%, GOS 3 = 21.8%, GOS 4 = 36.2%, and GOS 5 = 39.1%. Conclusion: Data on the epidemiology and quality management of early functional rehabilitation met the criteria set in 1992. Management of frequent multiple organ lesions and complications (57%) without referring the patient to another hospital and early functional outcome confirm the author's concept of neurosurgical early rehabilitation.[PUBLICATION ABSTRACT]