Long-term follow-up of severely brain injured patients in Martinique

Severe brain trauma was pointed out recently by the World Health Organisation as a worldwide problem. The aim of our study was to evaluate the long-term outcome of severely brain-injured patients. We studied retrospectively (2002) the data of 151 patients admitted to critical care between 1997 and 2000. The sex ratio (female/male) was 0.13, and mean age was 31 ± 17 years. Eighty-nine per cent had a low socioeconomic level. Fifty-one per cent (77 patients) were admitted during the weekend, and 57% (82 patients) during the night. Inhospital mortality and overall mortality were, respectively, 27% (41 patients) and 31% (47 patients). The mean SAPS II was 35 ± 14, ISS was 22 ± 11. Fifty-four per cent (81 patients) had a Glasgow Coma Scale < 8 before admission. Twenty-five per cent (38 patients) underwent initial surgery and 10% (15 patients) neurosurgery.

We joined the patients in order to evaluate them using the EBIS questionnaire. Thirty-six were lost and 12 patients were excluded because of associated diseases impairing their neurological status, so 56 patients were evaluated. They had no significant difference with the nonevaluated group according to the parameters already described. The Glasgow Outcome Scale (GOS) is presented in Table 1. Only 45% (24 patients) had a stay in a rehabilitation unit. Seventy-one per cent (40 patients) were staying in the family house when evaluated, 54% (30 patients) were unemployed. The most frequent medical complication was post-traumatic seizures (25% [14 patients]). Thirty-nine per cent (22 patients) had joints limitations, 39% (22 patients) had balance limitations, 32% (18 patients) had loss of visual acuity, and 45% (25 patients) had attention impairment. When tested, 43% (22/51 patients) had severe memory impairment. Visual and spatial memory (70% [35/50 patients]) and planning ability (70% [35/50 patients]) were also frequently impaired. Behavioural impairment was consecutive to depression (61% [33/54 patients]), anxiety (63% [34/54 patients]), or loss of emotional control (59% [32/54 patients]). Handicaps were sphincter incontinence (11% [6 patients]), loss of writing ability (51% [26/51 patients]), and loss of driving ability (44% [22/50 patients]). Sixty-three per cent (35 patients) had physical impairment (27% [15 patients]) or mental impairment (57% [32 patients]). The impact on the family resulted in medication therapy (34% [19 patients]), financial impairment (27% [15 patients]), and changes in the timetable (36% [20 patients]).

Table 1

Severe brain trauma leads to a marked impairment of the patient's autonomy. Public health measures are necessary to organize an early multidisciplinary approach that could improve the patient's rehabilitation and reintegration in the social network.