Li Lucia M, Dilley Michael D, Carson Alan, Twelftree Jaq, Hutchinson Peter J, Belli Antonio, Betteridge Shai, Cooper Paul N, Griffin Colette M, Jenkins Peter O, Liu Clarence, Sharp David J, Sylvester Richard, Wilson Mark H, Turner Martha S, Greenwood Richard
Imperial College London, London, UK and UK DRI Care Research & Technology Centre, London, UK.
Atkinson Morley Regional Neuroscience Centre, London, UK and Royal College of Psychiatrists, London, UK.
Clin Med (Lond). 2021 Mar;21(2):e198-e205. doi: 10.7861/clinmed.2020-0336.
Following hyperacute management after traumatic brain injury (TBI), most patients receive treatment which is inadequate or inappropriate, and delayed. This results in suboptimal rehabilitation outcome and avoidable detrimental chronic effects on patients' recovery. This worsens long-term disability, and magnifies costs to the individual and society. We believe that accurate diagnosis (at the level of pathology, impairment and function) of the causes of disability is a prerequisite for appropriate care and for accessing effective rehabilitation. An expert-led, integrated care pathway is needed to deliver accurate and timely diagnosis and optimal treatment at all stages during a TBI patient's care.We propose the introduction of a specialist interdisciplinary traumatic brain injury team, led by a neurosciences-trained brain injury consultant. This team would engage acutely and for a longer term after TBI to provide accurate diagnoses, which guides subsequent management and rehabilitation. This approach would also encourage more efficient collaboration between research and the clinic. We propose that the current major trauma network is leveraged to introduce and evaluate this proposal. Improvements to patient outcomes through this approach would lead to reduced personal, societal and economic impact of TBI.
在创伤性脑损伤（TBI）的超急性处理之后，大多数患者接受的治疗不充分、不恰当且延迟。这导致康复效果欠佳，并对患者的恢复产生可避免的有害慢性影响。这会使长期残疾情况恶化，并增加个人和社会的成本。我们认为，准确诊断（在病理学、损伤和功能层面）致残原因是提供适当护理和获得有效康复的前提条件。需要一条由专家主导的综合护理路径，以便在TBI患者护理的各个阶段进行准确、及时的诊断和最佳治疗。我们提议引入一个由接受过神经科学培训的脑损伤顾问领导的专科跨学科创伤性脑损伤团队。该团队将在TBI后急性期及更长时间内参与其中，以提供准确诊断，从而指导后续的管理和康复。这种方法还将鼓励研究与临床之间更高效的协作。我们提议利用当前的重大创伤网络来引入和评估这一提议。通过这种方法改善患者预后将减少TBI对个人、社会和经济的影响。
