Pathways of care the first year after moderate and severe traumatic brain injury-Discharge destinations and outpatient follow-up
Pathways of care the first year after moderate and severe traumatic brain injury-Discharge destinations and outpatient follow-up
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DOI：
10.3109/02699052.2014.982188
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发表时间：
2015-01-01
期刊：
影响因子：
1.9
通讯作者：
van der Naalt, Joukje
中科院分区：
文献类型：
--
作者：
de Koning, Myrthe E.;Spikman, Jacoba M.;van der Naalt, Joukje
主要目标：确定创伤性脑损伤(TBI)后第一年内的护理途径，并探讨所提供的护理是否与残存损伤有关。研究设计：对343例在一级创伤中心住院的中、重型颅脑损伤患者进行回顾性研究。方法和步骤：确定从医院到家庭的出院目的地和门诊频率。结果：尽管有认知(76%)、行为(67%)和身体(55%)方面的损害，大多数(94%)患者在受伤后1年仍能回家。每四名患者中就有一名严重残疾，32%的患者恢复了以前的工作水平。三分之二的患者作为第二出院目的地回家，50%的患者需要住院康复。几乎一半的患者需要门诊护理，主要是行为和认知障碍。每10名患者中就有1名咨询精神病医生，55%的患者结果不佳。在那些最初出院但没有随访的患者中，10%最终需要门诊康复。结论：大多数患者在受伤后一年内回家时仍有残存的损伤，并经常就医。这一发现值得进一步调查，以确定各种医学专家为长期社区融合而进行的适当的善后护理。
Primary objective: To determine the pathways of care within the first year after traumatic brain injury (TBI) and to explore whether provided care is related to residual impairments. Research design: Retrospective study of 343 patients with moderate and severe TBI admitted to a Level-1 trauma centre.Methods and procedures: Discharge destinations from hospital to home and frequency of outpatient visits were determined. Outcome was defined 1 year after injury by the Extended Glasgow Outcome Scale and Return to Work.Results: Most (94%) patients had returned home 1-year after injury despite cognitive (76%), behavioural (67%) and physical (55%) impairments. One in four patients was severely disabled and 32% had resumed work on a previous level. Two-thirds of all patients went home as secondary discharge destination and 50% needed inpatient rehabilitation. Almost half of patients needed outpatient care, mostly for behavioural and cognitive impairments. One in 10 patients consulted a psychiatrist, with 55% unfavourable outcome. Of those patients initially discharged to home without follow-up, eventually 10% needed outpatient rehabilitation.Conclusions: One-year after injury most patients had returned home with residual impairments and frequent medical consultations. This finding warrants further investigation to define appropriate aftercare by various medical specialists aimed at long-term community integration.