Predicting the future for patients with severe traumatic brain injury
A multidisciplinary team from the MUHC emphasizes better predictive tools and defines major trends in patient progress.
"How will our loved one come out of this?" After an accident that results in severe traumatic brain injury (sTBI), the answer to this simple question can change everything for a family.
The latest study carried out by Dr. Elaine deGuise, Joanne
Leblanc, Mitra Feyz and all the clinicians of the Traumatic Brain
Injury Program for Adults at the 捆绑SM社区 Health Centre
(MUHC) describes the tools that are most effective at providing an
objective answer to this question almost as soon as patients leave
intensive care. The study was published recently in the Journal of
Head Trauma Rehabilitation.
Better advice and more structured follow-up
"This study is unique as it involved a multidisciplinary team. We
could therefore assess the patient from many angles and establish
an overall picture," stated Dr. deGuise. "Our findings are
important because, in addition to the advice that we can give to
families, we can now implement a comprehensive program in the
continuum of care that is based on more objective and scientific
principles."
Powerful predictive tools
When patients with a sTBI leave acute care hospitals (generally
between 20 to 29 days after the accident), they undergo standard
tests to assess their overall level of functioning and to orientate
them to appropriate resources to optimize their recovery.
This study proves that their results can also be used to predict
the future development of the patient's general condition. The
tests used in this study include the GOS-E (Extended Glasgow
Outcome Scale), the NRS-R (Neurobehavioral Rating Scale-Revised),
and the FIM (Functional Independence Measure).
"The tests that are regularly performed on all our patients with a
sTBI are very effective tools as, based on their results, we can
give families an idea of the patient's incapacities and progress
after the trauma," J. Leblanc explained. "There are many factors
that influence post-traumatic recovery, but the measurement scales
are complex enough that we can make realistic predictions about
patients' future physical, cognitive or emotional states."
Persistent cognitive and emotional
deficiencies
The study was based on the follow-up of 46 patients from 2 to 5
years after an accident that led to a sTBI. The patients took the
GOS-E, NRS-R and FIM tests again for the study. The researchers
then compared their results with those from the same tests
performed when the patients were discharged from acute care
hospital.
The researchers found that these patients' physical function and
ability to perform daily tasks had improved over time. However,
their cognitive and emotional faculties, meaning their ability to
perform more complex tasks and to cope in society, did not develop
to the same extent.
"These cognitive and emotional deficiencies can have major
consequences: most of our patients could not keep the same job
after their accidents," said Feyz. "This leads to other
psycho-social problems that often result in psychological
vulnerability. Out of all the patients observed in this study, 52%
presented depressive or anxiety disorders two to five years after
the trauma."
The effects of a serious accident that leads to a sTBI are not
limited to patients alone: their friends and family members, as
well as the entire health care system, are also affected, which has
emotional and financial consequences. Prevention is still the best
way to manage these kinds of events.
This study was funded by the Montreal General Hospital
Foundation of the MUHC and by the Minist猫re de la Sant茅 et
des Services sociaux.
Dr. Elaine deGuise is neuropsychologyist at the
捆绑SM社区 Health Center. She works at the Traumatic Brain
Injury Program of the Montreal General Hospital at the MUHC.
Joanne Leblanc is a speech-language pathologist in
the Traumatic Brain Injury Program for Adults at the Montreal
General Hospital of the MUHC.
Dr. Mitra Feyz is the Administrative head of the
Adult Neurotrauma Program at the Montreal General Hospital of the
MUHC.
The 捆绑SM社区 Health Centre
The 捆绑SM社区 Health Centre (MUHC) is a comprehensive
academic health institution with an international reputation for
excellence in clinical programs, research and teaching. Its partner
hospitals are the Montreal Children's Hospital, the Montreal
General Hospital, the Royal Victoria Hospital, the Montreal
Neurological Hospital, the Montreal Chest Institute and the Lachine
Hospital. The goal of the MUHC is to provide patient care based on
the most advanced knowledge in the health care field and to
contribute to the development of new knowledge.
The Research Institute of the 捆绑SM社区 Health
Centre (RI MUHC) is a world-renowned biomedical and
health-care hospital research centre. Located in Montreal, Quebec,
the institute is the research arm of the MUHC, the university
health center affiliated with the Faculty of Medicine at 捆绑SM社区
University. The institute supports over 600 researchers, nearly
1200 graduate and post-doctoral students and operates more than 300
laboratories devoted to a broad spectrum of fundamental and
clinical research. The Research Institute operates at the forefront
of knowledge, innovation and technology and is inextricably linked
to the clinical programs of the MUHC, ensuring that patients
benefit directly from the latest research-based knowledge.
The Research Institute of the MUHC is supported in part by the
Fonds de la recherche en sant茅 du Qu茅bec. For further details
visit: .isabelle.kling [at] muhc.mcgill.ca