Medical management in south-west Sweden of children and adolescents with serious traumatic brain injury.
The acute care, rehabilitation and follow-up of traumatic brain injury (TBI) was studied retrospectively in children in south-western Sweden who were injured in the period 1987-1991. There were 210 children of whom 165 were alive at discharge after acute stage care (mean 15.7 days). In this group, only 32/165 (19 per cent) received rehabilitation, 29 of whom were road traffic accident victims. Of the 133 children who did not receive rehabilitation, 52 were severely injured according to the GCS (GCS 3-7), 31 were moderately injured (GCS 8-12) and 50 mildly injured (GCS 13-15). As many as 73/165 (44 per cent) were admitted to a neurosurgical unit and 53/73 (73 per cent) of these underwent neurosurgical operations. Systematic follow-up on an out-patient basis took place in 128/165 subjects (78%). It is noteworthy that 27/92 (29%) of the patients admitted to a general surgical unit and 8/16 (50%) of the patients admitted to a neurosurgical unit were not followed up after acute care. Multiple regression analysis identified the length of unconsciousness and length of care in the acute stage as the only factors of significance for receiving rehabilitation and follow-up. We conclude that road traffic accident victims, despite the fact that their TBI was not significantly more severe than the other groups received rehabilitation more frequently. The unsystematic management of paediatric TBI revealed in this study calls for a formalized programme of firstline service, rehabilitation and follow-up.
Bräcke Ostergård Regional Pediatric Rehabilitation Centre, Göteborg, Sweden.
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I
Emanuelson
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L
v Wendt
D000059:Accidents; D000063:Accidents, Traffic; D000208:Acute Disease; D000293:Adolescent; D001930:Brain Injuries / Q000209:etiology / Q000534:rehabilitation / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology