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Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome.

Nyholm L, Howells T, Enblad P, Lewén A - Ups. J. Med. Sci. (2013)

Bottom Line: The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay.Favorable outcome was achieved by 64% of adults.The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project.

Methods: Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and 'Talk and deteriorate' patients.

Results: Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults.

Conclusion: The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

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Related in: MedlinePlus

Six-month outcome (GOS) divided by severity of injury at admission to the NIC unit in adult patients ≥16 (n = 181) years included in the Uppsala TBI register 2008–2010. The severity of injuries was classified as mild, moderate, and severe using the GCS sum score. Untestable reactions were scored as 1 (no reaction) according to common practice. To avoid the problem with untestable reactions and over-classification of severity, a modified classification of the severity of the injury based on the GCS motor score was also used. (GR = good recovery; MD = moderate disability; SD = severe disability; VS = vegetative state; D = dead within six months; DM = data missing).
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Figure 3: Six-month outcome (GOS) divided by severity of injury at admission to the NIC unit in adult patients ≥16 (n = 181) years included in the Uppsala TBI register 2008–2010. The severity of injuries was classified as mild, moderate, and severe using the GCS sum score. Untestable reactions were scored as 1 (no reaction) according to common practice. To avoid the problem with untestable reactions and over-classification of severity, a modified classification of the severity of the injury based on the GCS motor score was also used. (GR = good recovery; MD = moderate disability; SD = severe disability; VS = vegetative state; D = dead within six months; DM = data missing).

Mentions: The mean GCS-M was 5.04 ± 1.23 (RLS 3.4 ± 1.6) (Table III) (11). The GCS classification was mild (GCS 13–15) (22%), moderate (GCS 9–12) (27%), and severe (GCS 3–8) (51%) (Figure 3). The co-occurrence of some specific diseases that may influence the outcome after TBI is presented in Table IV. The most frequent causes of injury were fall accidents (44%) and vehicle accidents (30%) (Table IV). In 24% of the cases the injury occurred under the influence of alcohol or other drugs (anamnestic or positive serum levels) (Table IV). The patients were transferred with specialized intensive care helicopter in 33% of the cases (Table IV). Acute evacuation of an extra-cerebral hematoma was done at the referral hospital in 8% of the patients before admission to the NIC unit in Uppsala (Table IV). The primary findings on the initial brain CT scan were contusions (33%) and acute subdural hemorrhage (23%) (Table IV). The most common injuries beside the brain injury were thoracic injuries (23%) followed by extremity injuries (15%), facial injuries (15%), and spinal column injuries (11%) (Table IV).


Introduction of the Uppsala Traumatic Brain Injury register for regular surveillance of patient characteristics and neurointensive care management including secondary insult quantification and clinical outcome.

Nyholm L, Howells T, Enblad P, Lewén A - Ups. J. Med. Sci. (2013)

Six-month outcome (GOS) divided by severity of injury at admission to the NIC unit in adult patients ≥16 (n = 181) years included in the Uppsala TBI register 2008–2010. The severity of injuries was classified as mild, moderate, and severe using the GCS sum score. Untestable reactions were scored as 1 (no reaction) according to common practice. To avoid the problem with untestable reactions and over-classification of severity, a modified classification of the severity of the injury based on the GCS motor score was also used. (GR = good recovery; MD = moderate disability; SD = severe disability; VS = vegetative state; D = dead within six months; DM = data missing).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713382&req=5

Figure 3: Six-month outcome (GOS) divided by severity of injury at admission to the NIC unit in adult patients ≥16 (n = 181) years included in the Uppsala TBI register 2008–2010. The severity of injuries was classified as mild, moderate, and severe using the GCS sum score. Untestable reactions were scored as 1 (no reaction) according to common practice. To avoid the problem with untestable reactions and over-classification of severity, a modified classification of the severity of the injury based on the GCS motor score was also used. (GR = good recovery; MD = moderate disability; SD = severe disability; VS = vegetative state; D = dead within six months; DM = data missing).
Mentions: The mean GCS-M was 5.04 ± 1.23 (RLS 3.4 ± 1.6) (Table III) (11). The GCS classification was mild (GCS 13–15) (22%), moderate (GCS 9–12) (27%), and severe (GCS 3–8) (51%) (Figure 3). The co-occurrence of some specific diseases that may influence the outcome after TBI is presented in Table IV. The most frequent causes of injury were fall accidents (44%) and vehicle accidents (30%) (Table IV). In 24% of the cases the injury occurred under the influence of alcohol or other drugs (anamnestic or positive serum levels) (Table IV). The patients were transferred with specialized intensive care helicopter in 33% of the cases (Table IV). Acute evacuation of an extra-cerebral hematoma was done at the referral hospital in 8% of the patients before admission to the NIC unit in Uppsala (Table IV). The primary findings on the initial brain CT scan were contusions (33%) and acute subdural hemorrhage (23%) (Table IV). The most common injuries beside the brain injury were thoracic injuries (23%) followed by extremity injuries (15%), facial injuries (15%), and spinal column injuries (11%) (Table IV).

Bottom Line: The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay.Favorable outcome was achieved by 64% of adults.The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

View Article: PubMed Central - PubMed

Affiliation: Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden.

ABSTRACT

Background: To improve neurointensive care (NIC) and outcome for traumatic brain injury (TBI) patients it is crucial to define and monitor indexes of the quality of patient care. With this purpose we established the web-based Uppsala TBI register in 2008. In this study we will describe and analyze the data collected during the first three years of this project.

Methods: Data from the medical charts were organized in three columns containing: 1) Admission data; 2) Data from the NIC period including neurosurgery, type of monitoring, treatment, complications, neurological condition at discharge, and the amount of secondary insults; 3) Outcome six months after injury. Indexes of the quality of care implemented include: 1) Index of improvement; 2) Index of change; 3) The percentages of 'Talk and die' and 'Talk and deteriorate' patients.

Results: Altogether 314 patients were included 2008-2010: 66 women and 248 men aged 0-86 years. Automatic reports showed that the proportion of patients improving during NIC varied between 80% and 60%. The percentage of deteriorated patients was less than 10%. The percentage of Talk and die/Talk and deteriorate cases was <1%. The mean Glasgow Coma Score (Motor) improved from 5.04 to 5.68 during the NIC unit stay. The occurrences of secondary insults were less than 5% of good monitoring time for intracranial pressure (ICP) >25 mmHg, cerebral perfusion pressure (CPP) <50 mmHg, and systolic blood pressure <100 mmHg. Favorable outcome was achieved by 64% of adults.

Conclusion: The Uppsala TBI register enables the routine monitoring of NIC quality indexes.

Show MeSH
Related in: MedlinePlus