Koning, M.E de (Myrthe) (2012) Chain of care perspective on the influence of personality changes on long-term outcome of traumatic brain injury. thesis, Medicine.
Full text available on request.Abstract
Objectives: To describe in detail the chain of care of patients with moderate to severe traumatic brain injury (TBI) after discharge from a level one trauma centre and to identify the long-term personality changes associated with TBI. In addition, it was evaluated whether the provided aftercare has been satisfactory for the patients and family members. Methods: Design/setting: Retrospective cohort study of patients admitted to a level one trauma centre. All adults admitted to the University Medical Centre Groningen (UMCG) with moderate to severe TBI during the period from 1997-2010 were included, severity was determined using the Glasgow Coma Scale (GCS). A questionnaire was sent two to five years post-trauma covering; discharge destination, medical specialist consultation in the first year after injury, personality changes perceived by both patients and family members and an aftercare evaluation. Results: Analyzing discharge destinations it was found that of the moderate TBI patients 60% were discharged to home, as opposed to 22% of severe TBI patients. In the moderate group, 31% of the patients were admitted to a rehabilitation centre at some point, as opposed to 65% in the severe group. In the moderate group most patients (98%) eventually returned home, compared to 92% of the severe group with 8% residing in a nursing home. Outpatient medical specialist contact showed an overall decline over the first year, with the exception of the psychiatric consultations which showed an increase up to 10%, indicating that psychiatric disturbances become more apparent over time. The response rate of the questionnaires was 62% with 38% of the patients reporting dissatisfaction concerning the provided aftercare. Behavioral changes were present in 75% of the patients responding to the questionnaire, with irritability being the most frequently reported. One third of the patients reported feeling depressed, making this the most common change in mood. Differences between patient and family reports on behavioral problems were revealed for the reports on irritability, lack of initiative, indifferent behavior and childish behavior, indicating a lack of insight among the TBI patients in our sample. A model for predicting personality changes revealed that the emotional subscale of the DOS, which is conducted one year post-trauma, provides a good basis for predicting behavioral changes among patients. Conclusion: Most of the TBI patients return to live at home eventually with 75% reporting changes in personality. Predicting long-term outcome based on one year outcome scores is possible, however complicated by patients’ impaired self-awareness. Shortcomings in the provided aftercare were reported by 38% of the patients, with the need for additional information regarding their condition being the most commonly mentioned.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Naalt, J. van der and Department of Neurology, UMCG |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:41 |
| Last Modified: | 25 Jun 2020 10:41 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/261 |
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