Moderate-to-severe traumatic brain injury in Eastern Norway : trends and challenges

Abstract

In recent years, there has been an ongoing debate in the health region of Eastern Norway concerning the management of patients with Traumatic Brain Injury (TBI), in order to better understand the extent of problems with management and to identify the high-risk groups. The debate has been hampered by a shortage of population-based studies of the TBI epidemiology, and a scarcity of information regarding the outcomes and the occurrence of disability in the Norwegian TBI population. The overall aim of this thesis was to describe epidemiological trends of hospital-treated TBI, TBI-related disabilities and health-related quality of life after moderate-to-severe TBI. The study findings indicated a trend towards a decreasing incidence of hospital-treated TBI in Norway, as reported in other countries. The study showed a bimodal age distribution, as the elderly and young children are those most affected by TBIs. Falls comprise the most frequent cause of TBI-related hospitalization. Transport accidents were the main cause of TBI in the 15-54 year age groups. A considerable number of the patients showed alcohol and drug use upon admission to the hospital. The majority of hospitalised patients had mild TBI. The elderly were more often found to have intracranial lesions. The majority of patients who were discharged to local care facilities belonged to the moderate-to-severe TBI group. At the one-year follow-up, patients with moderate-to-severe TBI were highly independent in physical but not cognitive activities. Social integration was not complete, and many patients reported participation restrictions. Better physical and mental health was associated with more severe injuries and higher levels of activities and productivity. Participation in productive activities was the strongest individual predictor of the physical and mental health dimensions. A majority of patients had good recovery or moderate disability at ten-year follow-up. However, health-related quality of life (HRQL) was significantly reduced in TBI survivors at one-year and ten-year follow-ups compared to the general Norwegian population. Our findings suggest that more effective programs related to falls and transport accidents are needed. Due to the extent of the use of alcohol and drugs at the time of injury, preventive efforts targeting risk populations are needed. To optimise the physical and mental health outcomes, clinicians need to ensure that the disability and health needs of patients with less severe intracranial injuries are identified and treated during the post-acute period. The decreased HRQL in the TBI survivors in the long-term perspective suggests the importance of support and care-availability in the “chronic” stage of TBI as well.