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|Katamnestische Verlaufsanalyse nach dekompressiver Kraniektomie bei 131 Patienten mit schwerem Schädel-Hirn-Trauma|
Ahmadi, Sebastian Alexander Kyros
|Main title||Katamnestische Verlaufsanalyse nach dekompressiver Kraniektomie bei 131 Patienten mit schwerem Schädel-Hirn-Trauma|
|Title variations||Long-term outome and its predictors in 131 patients undergoing decompressive craniectomy after severe traumatic brain injury|
|Author(s)||Ahmadi, Sebastian Alexander Kyros
Place of birth: Freiburg im Breisgau
|1. Referee||Prof. Dr. med. U. Meier|
|Further Referee(s)||Prof. Dr. med. J.C.W. Kiwit
Priv.-Doz. Dr. med. O. Süss
|Keywords||SHT; Outcome; Traumatic Brain Injury; Decompressive Craniectomy; TBI|
|Classification (DDC)||610 Medical sciences; Medicine|
|Summary||Objective: To assess long-term clinical outcome and identify its predictors at least 1 year after decompressive craniectomy (DC) in patients with severe traumatic brain injury (TBI).
Materials and Methods: 131 patients with severe TBI received DC at the Unfallkrankenhaus Berlin (UKB), a level I trauma center, between September 1997 and September 2005. Overall outcome was measured using the Glasgow Outcome Scale (GOS). The extended outcome analysis was performed using the Glasgow Outcome Scale Extended (GOSE), Short-Form 36 (SF-36), Beck Depression Inventory (BDI), Trail Making Test B (TMT-B), Digit-Symbol Test (DST) and Barthel Index (BI).
Results: 52.7% (n=69) of TBIs were due to motor vehicle traumas, 26.0% (n=34) were caused by falls, 13.7% (n=18) by acts of violence or suicide and 7.6% (n=10) by other causes. 63 Patients (48.1%) died during their initial hospital stay, another 27 (20.6%) were discharged in a vegetative state (GOS 2). 32 Patients (24.4%) were discharged with severe disability, another 9 (6.9%) with moderate disability (GOS 3 and 4, respectively). We identified multiple factors that were associated with the final outcome, such as age, initial Glasgow Coma Scale score, and status of basal cisterns on cranial CT. At the time of long-term outcome assessment 75 patients (67.7%) were either dead or in a vegetative state (GOS 1 and 2, respectively). We were able to recruit 30 patients with a GOS >2 for a detailed outcome analysis: Depression, reduced quality of life, neurologic deficits and reduced mental processing were common diagnoses and significantly more prevalent than in normative controls. At the same time patients achieved high Barthel Index scores.
Conclusions: Prognosis after severe TBI with DC is unfavorable and multifactorial. Our extended outcome analysis revealed multiple health-related problems in long-term survivors. Targeted therapies could improve outcomes in this complex patient cohort.
Dataobject from FUDISS_thesis_000000009660
|Number of pages||116|
|FU Department||Department of Medicine - Charité - University Medicine Berlin|
|Year of publication||2010|
|Document type||Doctoral thesis|
|Date of defense||2009-02-26|
|Created at||2009-11-30 : 12:05:22|
|Last changed||2010-02-19 : 11:59:19|