title: Updated periodic evaluation of standardized neurointensive care shows that it is possible to maintain a high level of favorable outcome even with increasing mean age.
abstract: BACKGROUND
  Periodic evaluation of neurointensive care (NIC) is important. There is a risk that quality of daily care declines and there may also be unrecognized changes in patient characteristics and management. The aim of this work was to investigate the characteristics and outcome for traumatic brain injury (TBI) patients in the period 2008-2009 in comparison with 1996-1997 and to some extent also with earlier periods.
  
  
  METHODS
  TBI patients 16-79 years old admitted from 2008 to 2009 were selected for the study. Glasgow Coma Scale Motor score at admission (GCS M), radiology, surgery, and outcome (Glasgow Outcome Extended Scale) were collected from Uppsala Traumatic Brain Injury Register.
  
  
  RESULTS
  The study included 148 patients (mean age, 45 years). Patients >60 years old increased from 16 % 1996-1997 to 30 % 2008-2009 (p < 0.01). The proportion of GCS M 4-6 were similar, 92 vs. 93 % (NS). In 1996-1997 patients, 73 % had diffuse injury (Marshall classification) compared to 77 % for the 2008-2009 period (NS). More patients underwent surgery during 2008-2009 (43 %) compared to 1996-1997 (32 %, p < 0.05). Good recovery increased and mortality decreased substantially from 1980-1981 to 1987-1988 and to 1996-1997, but then the results were unchanged in the 2008-2009 period, with 73 % favorable outcome and 11 % mortality. Mortality increased in GCS M 6-4, from 2.8 % in 1996-1997 to 10 % in 2008-2009 (p < 0.05); most of the patients that died had aggravating factors, e.g., high age, malignancy.
  
  
  CONCLUSIONS
  A large-proportion favorable outcome was maintained despite that patients >60 years with poorer prognosis doubled, indicating that the quality of NIC has increased or at least is unchanged. More surgery may have contributed to maintaining the large proportion of favorable outcome. For future improvements, more knowledge about TBI management in the elderly is required.
authors.affiliation: Department of Neuroscience, Section of Neurosurgery, Uppsala University, University hospital, 751 85, Uppsala, Sweden, samuel.lenell@akademiska.se.
authors.forename: Samuel
authors.initials: S
authors.lastname: Lenell
authors.forename: Lena
authors.initials: L
authors.lastname: Nyholm
authors.forename: Anders
authors.initials: A
authors.lastname: Lewén
authors.forename: Per
authors.initials: P
authors.lastname: Enblad
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000628:therapy*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011786:Quality Control; D011787:Quality of Health Care / Q000592:standards