Nada Andelic

Functional outcome and health-related quality of life 10 years after moderate-to-severe traumatic brain injury.

Objectives –  To describe the functional outcome and health‐related quality of life (HRQL) 10 years after moderate‐to‐severe traumatic brain injury (TBI).

Post-concussion symptoms after traumatic brain injury at 3 and 12 months post-injury: A prospective study

Primary objectives: To examine self-reported post-concussion symptoms from 3–12 months post-injury in adults with traumatic brain injury (TBI) and to identify predictors of these symptoms. Methods and procedures: A 1-year prospective study in Eastern Norway including 115 persons (16–55 years), with mild, moderate and severe TBI. The Rivermead Post Concussion Symptoms Questionnaire (RPQ) and Hospital Anxiety and Depression Scale (HADS) were administered. Magnetic resonance imaging (MRI) was performed at 12 months. Results: In the whole sample of TBI, 27.8% of cases developed post-concussion syndrome (PCS) at 3 months and 23.6% at 12 months post-injury. The mild and moderate groups showed a decline of PCS symptoms over time, in contrast to the severe TBI group. Greater levels of somatic, cognitive and anxiety symptoms at 3 months, as well as shorter PTA duration, were found to be important predictors for the severity of PCS symptoms at 12 months. Intracranial pathology, Glasgow Coma Scale (GCS) and demographic variables were not related to the severity of PCS symptoms. Conclusions: PCS symptoms were reported to a greater degree in persons with mild TBI at 3 months post-injury. One year after injury, no differences were found between TBI groups on the presence of PCS.

Does an Early Onset and Continuous Chain of Rehabilitation Improve the Long-Term Functional Outcome of Patients with Severe Traumatic Brain Injury?

There are currently no international guidelines regarding treatment in the early rehabilitation phase for persons with severe traumatic brain injury (TBI), and only a few studies have investigated the effect of integrating rehabilitation into acute TBI care. The aim of the study was to evaluate whether a continuous chain of rehabilitation that begins with the acute phase could improve the functional outcome of severe TBI patients, compared to a broken chain of rehabilitation that starts in the sub-acute phase of TBI. A total of 61 surviving patients with severe TBI were included in a quasi-experimental study conducted at the Level I trauma center in Eastern Norway. In the study, 31 patients were in the early rehabilitation group (Group A) and 30 patients were in the delayed rehabilitation group (Group B). The functional outcomes were assessed 12 months post-injury with the Glasgow Outcome Scale Extended (GOSE) and the Disability Rating Scale (DRS). A favorable outcome (GOSE 6-8) occurred in 71% of the patients from Group A versus 37% in Group B (p=0.007). The DRS score was significantly better in Group A (p=0.03). The ordinal logistic regression analysis was used to quantify the relationship between the type of rehabilitation chain and the GOSE. A better GOSE outcome was found in patients from Group A (unadjusted OR 3.25 and adjusted OR 2.78, respectively). These results support the hypothesis that better functional outcome occurs in patients who receive early onset and a continuous chain of rehabilitation.

Incidence of hospital-treated traumatic brain injury in the Oslo population.

Background: The aim of this prospective, population-based study is to present the incidence of hospital-treated traumatic brain injury (TBI) in Oslo, Norway, and to describe the severity of brain injuries and outcome of the patients’ acute medical care. Methods: Data were obtained from hospital admission registers and medical records from May 2005 to May 2006. The initial severity of TBI was measured by the Glasgow Coma Scale. The region is urban with a population of 534,129. Results: The 445 patients identified represent an annual incidence of 83.3/100,000. The median age was 29 years. The male:female ratio was 1.8:1.0. The highest incidence of TBI hospitalizations was found in the elderly males and the youngest children. The most common causes of TBI were falls (51%) and transport accidents (29.7%). Intracranial lesions were found more often in the elderly. The case fatality rate was 2.0/100 hospitalized patients and was highest in the elderly. Conclusions: The incidence of hospital-treated TBI in this study is considerably lower than that found in previous studies from Norway and Scandinavia. Despite the apparent decline in TBI hospitalization rates, our findings should also draw attention to the need for more effective preventive programmes related to falls. Studies that assess long-term consequences of TBI in elderly patients are also needed.

Disability, physical health and mental health 1 year after traumatic brain injury

Purpose. The purpose of this study was to assess disability and the physical and mental health status 1 year after traumatic brain injury (TBI), using the International Classification of Functioning, Disability and Health (ICF) as a conceptual model for understanding TBI disability. Methods. A prospective study of 85 patients with moderate-to-severe TBI (aged 16–55 years) due to injury occurring from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway were included. The severity of structural brain damage and overall trauma were used as indices of body structure impairments. Activity limitations were measured by the Functional Independence Measure, and participation restrictions were assessed via the Community Integration Questionnaire. Physical and mental health dimensions as reported on the Medical Outcome Survey Short-Form were chosen as outcome measures. Results. Roughly one quarter of the patients reported disability requiring personal assistance. One Quarter had major problems with social integration, and 42% were not working. Nearly half of the patients reported poor physical health, and 37% reported poor mental health. Regression models, including demographics, impairments, activity limitations and participation restrictions, accounted for 50% of the variance in physical health and 35% of the variance in mental health. More severe impairments, fewer activity limitations and fewer participation restrictions equated to better overall health. Conclusions. The results demonstrated that a significant proportion of TBI survivors face substantial disability and impaired overall health 1 year after injury. To optimise health and well-being outcomes, clinicians need to ensure that health needs of patients with less severe TBI are identified and treated during the post-acute period.

Functional level during sub-acute rehabilitation after traumatic brain injury: Course and predictors of outcome

Objectives: To describe the functional level during sub-acute rehabilitation after moderate and severe traumatic brain injury (TBI) and to evaluate the impact of pre-injury and injury-related factors as predictors of early recovery. Material and methods: A prospective study of 55 patients with moderate (n = 21) and severe (n = 34) TBI who received specialized, inpatient rehabilitation. Functional level was assessed by the FIM. Possible predictors were analysed in a regression model using FIM total score at discharge as outcome. Results: At discharge from sub-acute rehabilitation, on average 53 (±24) days post-injury, 57% of moderate TBI patients and 91% of severe TBI patients were still disabled with a FIM score < 126. The disability was mild (FIM 109–126) in 95% with moderate TBI and in 62% with severe TBI. The disability was severe (FIM < 72) in 24% with severe TBI. Only one patient did not improve. Predictors of functional level at discharge from rehabilitation were Glasgow Coma Scale (GCS) score at rehabilitation admission (B = 5.991), FIM total score at rehabilitation admission (B = 0.393), length of stay (LOS) in the rehabilitation unit (B = 0.264) and length of Post-Traumatic Amnesia (PTA) (B = −0.120). Together, these predictors explained 86% of variance of FIM total scores at discharge. Conclusion: Less than half of moderate TBI patients reached a normal functional level at discharge from sub-acute rehabilitation. A short PTA period, a high GCS score and FIM score at admission to rehabilitation and a longer stay in the rehabilitation unit were positive predictors of functional level at discharge.

Incidence of Hospital-Admitted Severe Traumatic Brain Injury and In-Hospital Fatality in Norway: A National Cohort Study

Aims: The aims of this study were to assess the incidence of hospital-admitted severe traumatic brain injury (TBI) in the adult population in Norway, and to determine whether there were differences in the epidemiological characteristics of severe TBI between rural and urban regions. Methods: A prospective population-based study on adults with severe TBI admitted to the Norwegian Trauma Referral Centres during the 2-year period (2009–2010). The electronic patient register was searched weekly for ICD-10 diagnoses of intracranial injuries (S06.0–S06.9) to identify patients. Severe TBI was defined as lowest unsedated Glasgow Coma Scale Score ≤8 during the first 24 h after injury. Results: The annual age-adjusted incidence was estimated at 5.2/100,000 in 2009 and 4.1/100,000 in 2010. The highest frequency of hospitalized patients was found among the youngest and the oldest age groups. The most common causes of injury were falls and transport accidents. The highest in-hospital case-fatality rate was found among the oldest patients. There were consistent epidemiological characteristics of severe TBI from both rural and urban regions. Conclusions: The incidence of hospital-admitted patients with severe TBI in this national study supports the declining incidence of TBI reported internationally. No major differences were found in epidemiological characteristics between the urban and rural parts of Norway.

Associations between disability and employment 1 year after traumatic brain injury in a working age population.

Objective: To investigate associations between disability and employment 1 year after traumatic brain injury (TBI) using the International Classification of Functioning, Disability and Health (ICF) as a conceptual model. Design and methods: A prospective study including 93 patients with moderate-to-severe TBI (aged 16–55 year). Disability components of the ICF model (impairments, activity limitations and participation restrictions) and personal factors (age, gender, pre-injury employment status) were used as independent variables. The outcome measure was employment at 1 year post-injury categorized into unemployed and employed groups. Results: Personal factors, impairments (brain injury severity, overall trauma severity and number of impaired body functions) and activity limitations (motor and cognitive abilities) accounted for 57% of the variance in employment outcome. Multivariate analyses showed that the probabilities of being employed 1 year post-injury were 95% lower for patients who were unemployed pre-injury (OR = 0.05), 74% lower for those with more severe brain injury (OR = 0.26) and 82% lower for those with more cognitive limitations (OR = 0.18). Conclusion: Rehabilitation professionals should take into account the importance of the ICF model when planning vocational rehabilitation interventions for individuals with TBI and focus on targeting modifiable aspects related to employment outcome, such as the individuals cognitive ability.

Predicting health-related quality of life 2 years after moderate-to-severe traumatic brain injury

To describe health‐related quality of life (HRQL) 2 years after moderate‐to‐severe traumatic brain injury (TBI) and to assess predictors of HRQL.

Effects of acute substance use and pre-injury substance abuse on traumatic brain injury severity in adults admitted to a trauma centre

BackgroundThe aims of this study were to describe the occurrence of substance use at the time of injury and pre-injury substance abuse in patients with moderate-to-severe traumatic brain injury (TBI). Effects of acute substance use and pre-injury substance abuse on TBI severity were also investigated.MethodsA prospective study of 111 patients, aged 16-55 years, injured from May 2005 to May 2007 and hospitalised at the Trauma Referral Centre in Eastern Norway with acute TBI (Glasgow Coma Scale 3-12). Based on structural brain damages shown on a computed tomography (CT) scan, TBI severity was defined by modified Marshall classification as less severe (score <3) and more severe (score ≥3). Clinical definition of substance use (alcohol and/or other psychoactive substances) was applied when hospital admission records reflected blood alcohol levels or a positive drug screen, or when a physician verified influence by examining the patient. Pre-injury substance abuse (alcohol and drug problems) was screened by using the CAGE questionnaire.ResultsForty-seven percent of patients were positive for substance use on admission to hospital. Significant pre-injury substance abuse was reported by 26% of patients. Substance use at the time of injury was more frequent in the less severe group (p = 0.01). The frequency of pre-injury substance abuse was higher in the more severe group (30% vs. 23%). In a logistic regression model, acute substance use at time of injury tended to decrease the probability of more severe intracranial injury, but the effect was not statistically significant after adjusting for age, gender, education, cause of injury and substance abuse, OR = 0.39; 95% CI 0.11-1.35, p = 0.14. Patients with positive screens for pre-injury substance abuse (CAGE ≥2) were more likely to have more severe TBI in the adjusted regression analyses, OR = 4.05; 95% CI 1.10-15.64, p = 0.04.ConclusionsAcute s ubstance use was more frequent in patients with less severe TBI caused by low-energy events such as falls, violence and sport accidents. Pre-injury substance abuse increased the probability of more severe TBI caused by high-energy trauma such as motor vehicle accidents and falls from higher levels. Preventive efforts to reduce substance consumption and abuse in at-risk populations are needed.