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Traumatic brain injury in children treated at the neurosurgical unit at Sahlgrenska University Hospital in 1987-1991 and 1997-2001: An analysis of the process of care
Institute of Clinical Sciences, Dept. of Pediatrics at Sahlgrenska Academy University of Gothenburg.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Institute of Neuroscience at Sahlgrenska Academy University of Gothenburg.
Institute of Neuroscience at Sahlgrenska Academy University of Gothenburg.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: In 1992, a new volume targeted treatment, the  “Lund Protocol”, was introduced in the field of neurosurgical care at Sahlgrenska University Hospital. The mortality rate for adults dropped markedly while the number of patients in a vegetative state remained at the same level. As  yet, changes in mortality and outcome for children have not been investigated in detail. Aim: To describe the causes and severity of injury, process of care from emergency care to rehabilitation, and the rate of received rehabilitation and to follow-up two cohorts treated for  child traumatic brain injury (CTBI) before and after the initiation of the  “Lund Protocol”. For group 2, treated after the initiation of  the  “Lund Protocol” an additional aim was to relate brain injury severity parameters in the acute care stage to functional outcome. Methods: A retrospective population-based study of patient records of former paediatric patients treated  neurosurgically for CTBI between 1987-1991 and 1997-2001. Epidemiological results are presented as descriptive statistics. To evaluate the relationship between brain injury parameters and outcome an exploratory cluster analysis was performed on the data from group 2. Results: For both groups traffic accidents were the most common cause of injury. The Glasgow Coma Scale indicated a more severe injury level in group1. The mortality rate in group1 was 8 %  compared with 2 % in group 2 (n.s.). The Glasgow outcome score was on the same level (median 5), and the rate of received rehabilitation was equally low in both groups, 27 % versus 33 %. The cluster analysis revealed that length of care and time in a respirator had a stronger relationship with outcome than the Reaction Level Scale (RLS). Conclusion: There is still no stable process of care after CTBI as 67 % in the later treated group did not receive rehabilitation and 50 % of those did not receive any medical check- ups in the long- term perspective. 

URN: urn:nbn:se:su:diva-38587OAI: diva2:311030
Available from: 2010-04-19 Created: 2010-04-19 Last updated: 2010-04-29Bibliographically approved
In thesis
1. Long-term cognitive outcome of childhood traumatic brain injury
Open this publication in new window or tab >>Long-term cognitive outcome of childhood traumatic brain injury
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

There is limited knowledge of cognitive outcome extending beyond 5 years after childhood traumatic brain injury, CTBI. The main objectives of this thesis were to investigate cognitive outcome at 6-14 years after CTBI, and to evaluate if advancements in the neurosurgical care, starting 1992, did influence long-term outcome and early epidemiology. An additional aim was to study the relationship between early brain injury parameters and early functional outcome. Study 1 evaluated cognitive progress during 14 years after CTBI, over three neuropsychological assessments in 8 patients with serious CTBI. Study 2 used patient records to investigate early epidemiology, received rehabilitation and medical follow up in two clinical cohorts, n=82 and n=46, treated neurosurgically for CTBI before and after 1992. An exploratory cluster analysis was applied to analyse the relation between early brain injury severity parameters and early functional outcome. In Study 3, participants in the two cohorts, n=18 and n=23, treated neurosurgically for CTBI before and after 1992, were subject to an extensive neuropsychological assessment, 13 and 6 years after injury, respectively. Assessment results of the two cohorts were compared with each other and with controls. Data were analysed with multivariate analyses of variance. Results and discussion. There were significant long-term cognitive deficits of similar magnitude and character in the two cohorts with CTBI, treated before and after the advancements in neurosurgical care. At 6-14 years after injury, long-term deficits in verbal intellectual and executive functions were found, and were discussed in terms of their late maturation and a decreased executive control over verbal memory-functions after CTBI. Visuospatial functions had a slightly better long-term recovery. The amount of rehabilitation received was equally low in both cohorts. The length of time spent in intensive care and the duration of care in the respirator may have a stronger relationship to early outcome than does a single measure of level of consciousness at admission. Main conclusions are that cognitive deficits are apparent at long-term follow up, 6-13 years after neurosurgically treated CTBI, even after advancements in the neurosurgical care in Sweden. Measures of verbal IQ, verbal memory and executive functions were especially low while visuospatial intellectual functions appear to have a better long-term recovery.

Place, publisher, year, edition, pages
Stockholm: Department of Psychology, Stockholm University, 2010. 74 p.
traumatic brain injury, childhood, adolescence, neurosurgical care, cognitive development, executive functions, memory, verbal functions, long-term outcome, recovery, rehabilitation, follow-up, cluster analysis
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Research subject
urn:nbn:se:su:diva-38530 (URN)978-91-7447-054-3 (ISBN)
Public defence
2010-05-28, David Magnusson salen (U31), hus 8, Frescati Hagväg 8, Stockholm, 10:00 (Swedish)
At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 3: Manuscript.Available from: 2010-05-06 Created: 2010-04-18 Last updated: 2011-05-25Bibliographically approved

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