Posttraumatic rehabilitation and one year outcome following acute traumatic brain injury (TBI): Data from the well defined population based German Prospective Study 2000–2002

Abstract

Follow-up examination to review the one-year outcome of patients after craniocerebral trauma with respect to health related quality of life (QoL) and social ré inté gration. The data are derived from the prospective controlled, well defined population based, multiple centre study that was performed in Germany for the first time in the years 2000–2001 with emphasis on quality management (structural, process, outcome) and regarding the patient’s age, physical troubles, and impaired mentalcognitive, neurobehavioral functioning. TBI severity assessment is according to the Glasgow Coma Scale (GCS) score. Early outcome after rehabilitation is assessed by the Glasgow Outcome Scale (GOS) score of patients following rehabilitation and of 63% of all TBI with the aid of follow-up examination (simplified questionnaire) after one year. Catchment areas are Hanover (industrial) and Münster (more rural) with 2,114 million inhabitants. TBI is diagnosed according to ICD 10 S-02, S-04, S-06, S-07, S-09 with at least two of the following symptoms: dizziness or vomiting; retrograde or anterograde amnesia, impaired consciousness, skull fracture, and/or focal neurological impairment. Within one year 6.783 patients (58% male) were examined in the regional hospitals after acute TBI. The regional TBI incidence regarding hospital admission was 321/100.000 TBI. 28% of patients were <1 to 15 years, 18% >65 years of age. GCS was only assessed in 55% of patients. They were 90.9% mild, 3.9% moderate, and 5.2% severe TBI. A total of 5.221 TBI (=77%) was hospitalised; 1.4% of them died. Only 258 patients (= 4.9%) of the hospitalized TBI received in-hospital neurorehabilitation (73% male), 68% within one month after injury. They were 10.9% severe, 23.4% moderate, and 65.7 mild TBI. 5% were <16 years, 25% >65 years. One-year follow-up examinations of 4307 individuals (=63.5% of all TBI) are discussed. A total of 883 patients (=20.6%) reported posttraumatic troubles, one half were >64 years. One hundred and sixty patients (= 3.8%) could manage their daily life only partly; 75 TBI (= 87.2%) following mild, 5.8% moderate, and 7% severe TBI. One hundred and sixteen patients could not at all manage their activities in training, at school, or in their jobs (TV =33 MTBI respectively 54%), 6 (= 10%) moderate, and 22 (= 36%) severe TBI. 2.8% of individuals failed when compared with their pre-traumatic situation. TBI severity, patient’s age, concomitant organ lesions, and complications influence health related QoL and early social ré inté gration.

W. J. Bock, Prof. emeritus Dr. med., former Director of the Neurochirurgische Universitätsklinik, Düsseldorf; W. Gobiet, Dr. med., former Head of the Neurological Clinic, Hessisch Oldendorf; U. Lehmann, Priv. Doz. Dr. med., Senior Registrar at the Department of Accident, Hand, and Restorative Surgery of the Saarland University, Homburg; Saar, K. Mayer, Prof, emeritus. Dr. med., Industrial Cooperative Compensation Fund Accident Clinic, Tübingen; E. Rickels, Prof. Dr. med., Head Department of Neurosurgery, Clinic of the Medical University, Ulm, former Senior Registrar, Neurosurgical Clinic of the Medical University, Hannover (MHH); B. Sens, Dr. Head of the Centre for Quality Management in Healthcare, Physicians’ Chamber of Lower Saxony, Hannover; H. D. Wassmann, Prof. Dr., Director of the Neurosurgical University Clinic UKM; Münster, P. Wenzlaff, Medical statistics, Centre for Quality Management in Healthcare, Physicians’ Chamber of Lower Saxony, Hannover; R. Wiechers, former Managing Director of the Curatorium CNS for Accident Victims with Injuries of the Central Nervous System and of the Hannelore Kohl Foundation; Bonn, K. R. H. von Wild, Dr. med. Prof, of Neurosurgery, Medical Faculty of the Westphalian Wilhelms-University Münster, Former Head of the Neurosurgical Department and the Unit for Posttraumatic Early Rehabilitation, Clemenshospital, Teaching Hospital, Münster, Germany.