Keleman Nataša, Krasnik Rastislava, Mikov Aleksandra, Dragičević-Cvjetković Dragana
Clinical Rehabilitation Service, University Clinical Center of the Republic of Srpska, Banja Luka, The Republic of Srpska, Bosnia and Herzegovina.
Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia.
Front Neurol. 2023 Sep 28;14:1269564. doi: 10.3389/fneur.2023.1269564. eCollection 2023.
The COVID-19 pandemic has placed a tremendous burden on the healthcare system. Patients with traumatic brain injury (TBI) have to get fast track treatment which is independent of environmental conditions. The aim of this study was to investigate epidemiological and clinical outcomes of early rehabilitation and compare it with the literature data during the non-COVID-19 period.
A retrospective study included 174 patients with TBI, average 57 ± 19.08 years. They all underwent treatment in the University Clinical Center, Republic of Srpska, Bosnia and Herzegovina during the period January-December 2021. We have analyzed the epidemiological data and clinical course in 174 patients as well as the outcome of early rehabilitation in 107 patients. In clinical evaluation were used: Glasgow Coma Score (GCS), Functional Independence Measure (FIM) and Barthel Index on admission and at discharge, as well as Glasgow Outcome Scale (GOS) at discharge. ANOVA, SPANOVA, Student test and Pearson correlation coefficient were used in statistical analysis. The value ( < 0.05) was used for statistical significance.
A total of 174 patients with TBI were included in this study. Most of the patients ( = 94) were older than 60, male ( = 125) and the most frequent cause of TBI was falling over ( = 88). About a half ( = 92) had a mild TBI, almost one third of the sample had moderate ( = 52), while only 30 patients had severe TBI. Total of 139 (80.3%) patients had the improved outcome, the worsening was registered in 2 (1.2%), while the fatal outcome was reported with 33 (18.5%) patients. When comparing the scores on admission and at discharge, the improvement of mean parameter values was reported for GCS (9.9 vs. 14.1), for Barthel Index (57.25 vs. 86.85), and for FIM (67.35 vs. 105.15), ( < 0.001). A complete recovery at discharge was found in 63.79%, a mild deficit in 8.62%, while serious deficit was found with 6.32%, and vegetative state with 2.29% patients.
The COVID-19 pandemic had a significant effect on the epidemiological data but not on the clinical outcome of patients with TBI. Early rehabilitation proved to be effective and to contribute to positive treatment outcome.
新冠疫情给医疗系统带来了巨大负担。创伤性脑损伤（TBI）患者必须获得不受环境条件影响的快速治疗。本研究的目的是调查早期康复的流行病学和临床结果，并与非新冠疫情期间的文献数据进行比较。
一项回顾性研究纳入了174例TBI患者，平均年龄57±19.08岁。他们均于2021年1月至12月期间在波斯尼亚和黑塞哥维那斯普斯卡共和国大学临床中心接受治疗。我们分析了174例患者的流行病学数据和临床病程，以及107例患者的早期康复结果。临床评估采用入院时和出院时的格拉斯哥昏迷量表（GCS）、功能独立性测量（FIM）和巴氏指数，以及出院时的格拉斯哥预后量表（GOS）。统计分析采用方差分析、协方差分析、学生检验和皮尔逊相关系数。P值（<0.05）用于表示统计学显著性。
本研究共纳入174例TBI患者。大多数患者（n=94）年龄超过60岁，男性（n=125），TBI最常见的原因是摔倒（n=88）。约一半（n=92）患者为轻度TBI，近三分之一的样本为中度（n=52），而只有30例患者为重度TBI。共有139例（80.3%）患者预后改善，2例（1.2%）病情恶化，33例（18.5%）患者报告死亡。比较入院时和出院时的评分，GCS（9.9对14.1）、巴氏指数（57.25对86.85）和FIM（67.35对105.15）的平均参数值均有改善（P<0.001）。出院时完全恢复的患者占63.79%，轻度缺陷的患者占8.62%，重度缺陷的患者占6.32%，植物状态的患者占2.29%。
新冠疫情对流行病学数据有显著影响，但对TBI患者的临床结果没有影响。早期康复被证明是有效的，并有助于取得积极的治疗结果。
