Status:
completed 03/2018
Aims:
The study consists of two different parts, an epidemiological main project, and an additional subproject ("mild TBI"). The aim of the main project was the documentation of epidemiology, treatment and outcome of patients after traumatic brain injury (TBI) who were treated in one of the participating hospitals, the comparison of the results to the results of the "Hannover-Münster-study" 2000/2001 with respect to current guidelines and quality standards, and the identification of factors which have a negative impact on clinical outcome. The aim of the subproject was the assessment of frequency and temporal dynamics of neuropsychological deficits after mild TBI, as well as its relationship to posttraumatic MRI abnormalities.
Activities/Methods:
In the main project, all patients aged ≥ 18 years with different degrees of TBI who were newly diagnosed and treated between 01.10.2014 and 30.09.2015 in the participating hospitals were prospectively documented. In all patients, pre-hospital and in-hospital treatment as well as rehabilitation was documented. Besides, standardized telephone interviews were conducted after 3 and 12 months. In the subproject, the frequency and temporal dynamics of neuropsychological deficits were assessed in a subgroup of patients with mild TBI (concussion), as well as symptoms, neurological signs and abnormalities in EEG and MRI. Patients were examined within the first 4 weeks after trauma, and 3 and 12 months later.
Results:
Main project:
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In the main project, 3524 patients were included. About 2/3 of them were hospitalized, and 12,4% of the
hospitalized patients received consecutive rehabilitation. Most TBI were classified as mild according to Glasgow Coma Scale (GCS). The predominant cause of TBI were falls, followed by road accidents and trauma by external force. Among road
accidents, cyclists who did not wear a helmet were the most prominent group.
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In comparison to the "Hannover-Münster-study", a higher adherence to current guidelines was found: In the
current study, e.g. much less X-rays of the skull were taken, the GCS more often was documented, and much
more patients received anesthetic drugs already in the prehospital setting.
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Elevated age and female gender were factors with a negative impact on clinical outcome.
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Patients who reported persisting symptoms 3 months after trauma in general still reported these symptoms 12
months after trauma. This finding supports the recommendation of the DGUV quality standards that "Brain
Check" should be performed if patients still have symptoms or not yet have returned to work 3 months after
trauma.
Subproject:
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In the subproject, 34 patients were included.
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After 12 months, neuropsychological testing revelaed abnormalities in about 1/4 of the patients who had
suffered from mild TBI. Mostly, but not always, these patients had posttraumatic abnormalities on MRI, usually
being visible only on MRI sequences sensitive to hemosiderin (T2*, SWI).
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Therefore each MRI conducted in patients after mild TBI must inlcude such specialized MRI sequences sensitive
to hemosiderin. If symptoms persist after mild TBI, MRI and neuropsychological testing should be performed no
later than 3 months after trauma, which also supports current recommendations of the DGUV quality standards.
Last Update:
20 Nov 2019
