Preditores de qualidade de vida após trauma crânio-encefálico moderado a grave

Weber, Karina Tavares; Guimarães, Viviane Assunção; Pontes Neto, Octávio M; Leite, João P.; Takayanagui, Osvaldo Massaiti; Santos-Pontelli, Taiza E. G.

doi:10.1590/0004-282X20160053

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ARTICLE • Arq. Neuro-Psiquiatr. 74 (5) • Maio 2016 • https://doi.org/10.1590/0004-282X20160053 copiar

Preditores de qualidade de vida após trauma crânio-encefálico moderado a grave

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo

Verificar correlações entre idade, gravidade do trauma, tempo de hospitalização (TH), cognição, capacidade funcional e qualidade de vida (QV) seis meses após alta hospitalar (AH) de vítimas de trauma crânio-encefálico (TCE).

Método

50 pacientes tratados em um hospital de emergência brasileiro foram avaliados na admissão, AH e seis meses após AH. O protocolo de avaliação consistia em Escala Abreviada de Lesões, Índice de Gravidade de Lesão, Escala de Coma de Glasgow (ECG), Escore de Trauma Revisado (RTS), teste Mini-Mental, Índice de Barthel e Questionário Breve de QV da Organização Mundial de Saúde.

Resultados

Forte correlação negativa foi observada entre TH e ECG e TH e RTS. Correlação quase máxima foi observada entre RTS e ECG e capacidade funcional e ECG na AH. Idade e TH foram considerados preditores independentes de QV.

Conclusão

Idade e TH são preditores independentes de QV após TCE moderado e grave.

traumatismos encefálicos; epidemiologia; qualidade de vida

Variables	Number	%
Gender
Male	44	88
Female	6	12
Race/ethnicity
White	44	88
Black	3	6
Mullato	3	6
Age (years)
18 - 25	14	28
26 - 35	11	22
36 - 45	10	20
45 - 55	4	8
56 - 65	6	12
66 or older	5	10
Education
Illiterate	3	6
Incompleted primary	8	16
Completed primary	8	16
Incompleted gymnasium	11	22
Completed gymnasium	2	4
Incompleted high school	7	14
Completed high school	10	20
Incompleted college	1	2

Variables	number	%
Causes of TBI
Automobile	16	32
Fall	12	24
Bike	6	12
Running over	6	12
Motorcycling	3	6
Physical aggression	6	12
Firearm	1	2
Causes of TBI according to age group
15 – 25 years old
Traffic accidents of motor vehicles	10	20
Aggressions	1	2
Accidental falls	2	4
Homicide and injuries caused intentionally by others	1	2
26 – 35 years old
Traffic accidents of motor vehicles	9	18
Aggressions	2	4
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
36 – 45 years old
Traffic accidents of motor vehicles	5	10
Aggressions	2	4
Accidental falls	3	6
Homicide and injuries caused intentionally by others	0	0
46 – 55 years old
Traffic accidents of motor vehicles	3	6
Aggressions	1	2
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
56 – 65 years old
Traffic accidents of motor vehicles	2	4
Aggressions	3	6
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
66 – 85 years old
Traffic accidents of motor vehicles	2	4
Aggressions	0	0
Accidental falls	4	8
Homicide and injuries caused intentionally by others	0	0
Other lesions
Head	50	100
Face	15	30
Neck	1	2
Chest	11	22
Column	4	8
Abdomen	7	14
Upper limbs	14	28
Lower limbs	10	20
Pelvis	1	2

Groups (age range)	Number of subjects	ISS admission	RTS admission	Glasgow admission	BI		MMSE

					discharge	6 months	discharge	6 months

		mean±SD	mean±SD	median	mean±SD	mean±SD	mean±SD	mean±SD

		(min-max)	(min-max)	(min-max)	median (min-max)	median (min-max)	(min-max)	(min-max)
Group A (18–85 years)	50	17.6 ± 8.6	6.3 ± 1.3	8	29.8 ± 30.1	83 ± 30.2	11.4 ± 8.5	23.2 ± 7.2
Group A (18–85 years)	50	(4–47)	(7.8–4.0)	(3–15)	25 (0–100)	100 (0–100)	(0–27)	(0–30)
Group B (18–25 years)	14	19.7 ± 5.6	6.3 ± 1.3	8	29.2 ± 23.4	95.4 ± 10.5	15.4 ± 9.3	27.25 ± 3.3
Group B (18–25 years)	14	(10–30)	(4.1–7.8)	(3–15)	30 (0–65)	100 (65–100)	(0–27)	(21–30)
Group C (26–35 years)	8	16.2 ± 9.3	6 ± 1.5	8	19.4 ± 30.8	64.3 ± 41.6	7.6 ± 8.3	18.7 ± 9.7
Group C (26–35 years)	8	(10–34)	(4–7.8)	(3–14)	0 (0–85)	85 (0–100)	(0–17)	(0–29)
Group D (36–45 years)	12	21 ± 12	5.9 ± 1.3	7.5	33.75 ± 33.5	88.9 ± 24,6	9.9 ± 6.7	22.9 ± 3.9
Group D (36–45 years)	12	(5–47)	(4–7.8)	(3–14)	27.5 (0–100)	100 (25–100)	(0–17)	(17–28)
Group E (45–55 years)	5	17 ± 1.73	5.9 ± 1.2	6	38 ± 36.8	100 ± 0	13.2 ± 9.3	27 ± 2.9
Group E (45–55 years)	5	(14–18)	(4.5–7.8)	(5–15)	20 (0–80)	100 (100–100)	(0–24)	(23–30)
Group F (56–65 years)	6	13 ± 6.6	7.2 ± 1	13.5	40.8 ± 29.1	78 ± 30.9	13.3 ± 7.4	23 ± 5
Group F (56–65 years)	6	(5–22)	(5.97–7.8)	(7–15)	35 (10–85)	100 (35–100)	(0–20)	(16–28)
Group G (66–85 years)	5	11.6 ± 8.2	7.2 ± 0.6	12	17 ± 38	45 ± 50.7	5.2 ± 8.3	14.3 ± 15
Group G (66–85 years)	5	(4–24)	(6.6–7.8)	(9–15)	0 (0–85)	35 (0–100)	(0–19)	(0–30)

Dependent variable	Independent Variable	Spearman Correlation	Linear Regression

		p-value (r)	95%CI	Alpha	Beta	p-value	R²2. Carvalho AO, Bez Júnior A. Caracterização das vítimas de trauma assistidas por um serviço de atendimento pré-hospitalar. Einstein. 2004;2(3):199-205.
Psychological domain	Age	0.04 (0.33)	0.14 to -0.01	15.61	0.33	0.04	0.11
Psychological domain	LOS	0.02 (0.37)	-0.91 to -0.01	17.41	0.80	0.02	0.14
Environmental domain	Age	0.02 (0.36)	0.12 to -0.01	16.30	0.06	0.02	0.15
Environmental domain	LOS	p = 0.17 (-0.23)	NA	NA	NA	NA	NA
Physical domain	Age	p = 0.22 (-0.20)	NA	NA	NA	NA	NA
Physical domain	LOS	0.01 (0.42)	-0.09 to -0.01	15.81	0.05	0.04	0.11

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[1] Correspondence: Taiza E. G. Santos-Pontelli; Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo; Av. dos Bandeirantes, 3900; 14049-900 Ribeirão Preto SP, Brasil. E-mail: taiza@fmrp.usp.br