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Predicting the future for patients with severe traumatic brain injury

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Published: 17 Nov 2008

A multidisciplinary team from the MUHC emphasizes better predictive tools and defines major trends in patient progress.

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 McGill University 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 Ministère de la Santé et des Services sociaux.

Dr. Elaine deGuise is neuropsychologyist at the McGill University 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 McGill University Health Centre
The McGill University 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. www.muhc.ca

The Research Institute of the McGill University 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 McGill 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 santé du Québec. For further details visit: www.muhc.ca/research.isabelle [dot] kling [at] muhc [dot] mcgill [dot] ca ()

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Contact: Isabelle Kling
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