title: Functional survival after acute care for severe head injury at a designated trauma center in Hong Kong.
abstract: BACKGROUND
  Severe head injury is known to be a major cause of early mortalities and morbidities. Patients' long-term outcome after acute care, however, has not been widely studied. We aim to review the outcome of severely head-injured patients after discharge from acute care at a designated trauma center in Hong Kong.
  
  
  METHODS
  This is a retrospective study of prospectively collected data of patients admitted with severe head injuries between 2004 and 2008. Patients' functional status post-discharge was assessed using the Extended Glasgow Outcome Score (GOSE).
  
  
  RESULTS
  Of a total of 1565 trauma patients, 116 had severe head injuries and 41 of them survived acute hospital care. Upon the last follow-up, 23 (56.1%) of the acute-care survivors had improvements in their GOSE, six (11.8%) experienced deteriorations, and 12 (23.5%) did not exhibit any change. The greatest improvement was observed in patients with GOSE of 5 and 6 upon discharge, but two of the 16 patients with GOSE 2 or 3 also had a good recovery. On logistic regression analysis, old age and prolonged acute hospital stay were found to be independent predictors of poor functional outcome after a mean follow-up duration of 42 months.
  
  
  CONCLUSIONS
  Multidisciplinary neurorehabilitation service is an important component of comprehensive trauma care. Despite significant early mortalities, a proportion of severely head-injured patients who survive acute care may achieve good long-term functional recovery.
authors.affiliation: Division of Neurosurgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: Benedict B T
authors.initials: BB
authors.lastname: Taw
authors.forename: Alan C S
authors.initials: AC
authors.lastname: Lam
authors.forename: Faith L Y
authors.initials: FL
authors.lastname: Ho
authors.forename: K N
authors.initials: KN
authors.lastname: Hung
authors.forename: W M
authors.initials: WM
authors.lastname: Lui
authors.forename: Gilberto K K
authors.initials: GK
authors.lastname: Leung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000401:mortality / Q000534:rehabilitation / Q000628:therapy*; D004638:Emergency Treatment; D005260:Female; D005500:Follow-Up Studies; D006723:Hong Kong; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers / Q000706:statistics & numerical data*; D016896:Treatment Outcome