Author(s): Bell C.; Hackett J.; Hall B.; Pulhorn H.; McMahon C.J.; Bavikatte G.
Source: Brain Injury; 2017; vol. 31 (no. 6); p. 796-797
Publication Date: 2017
Publication Type(s): Conference Abstract
Available in full text at Brain Injury – from Informa Healthcare
Abstract:Objectives: The Walton Centre NHS Foundation Trust is part of the major trauma centre collaborative for the North West of England, UK. Of the 2.4 million patients under the remit of this collaborative, the Walton Centre as a specialist neuroscience institution provides surgical intervention and rehabilitation services for those admitted following traumatic brain injury (TBI). TBI specifically accounts for 3.4% of emergency department admissions in the UK. Main Outcome Measure: A broad spectrum of physical, cognitive and psychological sequelae occurring in patients with TBI has been identified as late as 2 years post injury. These symptoms have been found in patients regardless of the severity of their original brain injury. Indeed, those with mild injury may often fare worse due to oversights in management early on, as early rehabilitation has been shown to be associated with better outcomes. To aid in the management of such patients, a combined, multidisciplinary neurotrauma clinic led by a neurosurgeon and specialist in neurorehabilitation has been initiated at The Walton Centre. The clinic provides specialist management for the wide range of problems that follow TBI. The primary objective of this study is to describe outcomes of patients following TBI who attended a multidisciplinary neurotrauma clinic at a tertiary centre. Methods: All patients who had attended the clinic since its inception were eligible. The following data was collected for each patient: basic demographics, mechanism and severity of injury, initial CT findings, information on hospital stay and discharge, symptomatology in clinic, and outcomes (including further investigations, referral to other specialties or services and return to employment). Results: 305 patients (98.1%) had clinic notes available and were included in the study. Mean age was 47.5 and the majority of patients were male (72.1%). The commonest mechanism of injury was falls (53.1%). 17.4% of injuries were classed as mild, 68.2% as moderate, and 14.1% as severe. Frontal (21.6%) and temporal (16.1%) injuries were the commonest locations with contusions (37.4%) and subdural haematomas (27.9%) the commonest type of injury found on initial CT scan. In clinic the most frequent physical complaints were headache (47.9%), memory problems (42.0%) and loss of driver’s licence (28.5%). 41.6% were referred to further services or other specialties, the commonest being psychology (19.3%) and neuropsychiatry (18.4%). Of 184 patients known to be in employment before their injury, only 48.4% of these had returned to work before their last appointment. Further analysis of the data is ongoing. Conclusions: The information gathered in this study about the characteristics of the TBI population and their outcomes should allow for better targeting of suitable patients for referral to a multidisciplinary clinic. This kind of data is essential for planning of health care provision, and improving efficiency and ultimately patient outcome.