Improving the system of neurotraumatology care in the metropolis for elderly victims with severe traumatic brain injury (on the example of Saint Petersburg)
https://doi.org/10.24884/0042-4625-2022-181-4-13-19
Abstract
The OBJECTIVE was to study the dependence of the results of neurosurgical treatment of elderly patients with severe TBI on the organizational transformations of the neurotraumatology care system on the metropolis – Saint Petersburg scale.
METHODS AND MATERIALS. 1228 victims aged 60 to 75 years with severe TBI (men – 982 (80.0 %) people, women – 246 (20.0 %) people) who were treated in the neurotraumatology centers of St. Petersburg in the period before (2007–2009) and after (2010–2020) organizational transformations.
RESULTS. The measures implemented on a megalopolis scale have made it possible to improve the system of neurotraumatology care in St. Petersburg due to optimal routing and rapid delivery of elderly victims with severe TBI to neurotraumatology centers, performing brain SCT scans around the clock during the first 6 hours from the moment of their delivery to the hospital, conducting minimally invasive including neuroendoscopic brain surgery, performing early rehabilitation treatment in the conditions of neurotraumatology centers with further continuation in inpatient centers and medical rehabilitation departments.
CONCLUSION. Modernization of the system of neurotraumatology care for elderly patients with severe TBI on the metropolis – St. Petersburg scale allowed to reduce the frequency of functional disorders, infectious and inflammatory complications, the rate of temporary disability, disability and mortality of victims.
About the Authors
Yu. A. Shcherbuk
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Shcherbuk Yuriy A., Dr. of Sci. (Med.), Professor, Academician of the RAS, Dean of the Faculty of Dentistry and Medical Technologies, Head of the Department of Neurosurgery and Neurology
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
D. Yu. Maday
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Maday Dmitriy Yu., Dr. of Sci. (Med.), Professor, Head of the Department of Maxillofacial Surgery and Surgical Dentistry
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
A. Yu. Shcherbuk
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Shcherbuk Alexandr Yu., Dr. of Sci. (Med.), Professor, Professor of the Department of Neurosurgery and Neurology
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
V. V. Donskov
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Donskov Victor V., Cand. of Sci. (Med.), Associate Professor of the Department of Maxillofacial Surgery and Surgical Dentistry
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
E. V. Cherepanova
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Cherepanova Ekaterina V., Cand. of Sci. (Med.), Associate Professor of the Department of Fundamental Problems of Medicine and Medical Technologies
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
R. V. Tyurin
Saint-Petersburg State University
Russian Federation
Competing Interests:
Russian Federation
Tyurin Roman V., Assistant of the Department of Neurosurgery and Neurology
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
D. V. Leyko
Saint-Petersburg State University
Competing Interests:
Leyko Dmitriy V., Assistant of the Department of Neurosurgery and Neurology
7/9, Universitetskaya Emb, Saint Petersburg, 199034
Competing Interests:
The authors declare no conflict of interest
References
1. Potapov A. A., Krylov V. V., Petrikov S. S. et al. Focal brain injury. Clinical recommendations. Moscow, 2022:82. (In Russ.).
2. Traumatic brain injury: Clinical guide: in 3 volumes /eds. by А. N. Коnоvalov, А. А. Potapov, L. B. Lihterman. Moscow, Antidor, 1998–2002. (In Russ.).
3. Krylov V. V., Petrikov S. S. Neuroresuscitation: A Practical Guide. Moscow, 2010:22–24. (In Russ.).
4. Krylov V. V. Surgery for severe traumatic brain injury // eds. by Krylov V. V., Talypov A.E., Levchenko О. V. Moscow, 2019:647. (In Russ.).
5. Tagliaferri F., Compagnone C., Korsic M. et al. A systematic review of brain injury epidemiology in Europe // Acta Neurochir. 2006;148(3):255–268.
6. Godoy D. A. et al. General care in the management of severe traumatic brain injury: Latin American consensus // Medicina Intensiva (English Edition). 2020;44(8):500–508.
7. Gravesteijn B. Y. et al. Tracheal intubation in traumatic brain injury: a multicentre prospective observational study // British journal of anaesthesia. 2020;125(4):505–517.
8. Chau C. Y. C. et al. Optimal timing of external ventricular drainage after severe traumatic brain injury: a systematic review // Journal of clinical medicine. 2020;9(6):1996.
9. Teasdale G. M. The story of the development and adoption of the Glasgow Coma Scale: part I, the early years // World Neurosurg. 2020;134:311– 322. Doi: 10.1016/j.wneu.2019.10.193.
10. Dhillon N. K. et al. Early Antibiotic Administration is Independently Associated with Improved Survival in Traumatic Brain Injury // Journal of Surgical Research. 2022;270:495–502.
11. Yarikov A. V., Fraerman A. P., Ermolaev A. Yu., Smirnov I. I., Rudnev Yu. V. et al. Traumatic brain injury: current state of the problem, epidemiology and aspects of surgical treatment // Amurskiy med. zhurn. 2020;2(30):57–65 (In Russ.).
12. Lilley E. J. Scott J. W., Weissman J. S. et al. End-of-Life Care in Older Patients After Serious or Severe Traumatic Brain Injury in Low-Mortality Hospitals Compared With All Other Hospitals // JAMA Surg. 2018; 153(1):44–50. Doi: 10.1001/jamasurg.2017.3148.
13. Shcherbuk Y. A., Zacharov V. I., Shcherbuk A. Y., Donskov V. V., Smochilin A. G. et al. The system of medical rehabilitation of elderly victims with severe traumatic brain injury in a megalopolis // Uspehi gerontol. 2019;32(1–2):133–136. (In Russ.).
14. Skull and Brain injuries / Neurosurgery: Textbook // eds. by B. V. Gaydar, D. V. Svistov. SPb., VMedA. 2018:327. (In Russ.).
15. Neurosurgery and neuro-resuscitation / eds. by V. V. Krylov. Мoscow, АВV-press. 2018:792. (In Russ.).
16. Neurology. National leadership. Short Edition / eds. by Е. I. Guseva, А. N. Konovalova, B. Geht. Мoscow, GEOTAR-Мedia, 2018:688. (In Russ.).
17. Mullagulov T. R., Talipov T. E., Grin A. A., Kordonovskiy A. Yu. Treatment outcomes in patients with traumatic parenchymal brain injuries using intracranial pressure monitoring // Rus. Neurosurgery // Journ. of A. L. Polenov. 2022;XIV: «Polenovskie chteniya»: materiali XXI Vseros. nauchpraktich. konf. SPb, 2022:187. (In Russ.).
18. Krivolapov А. А., Shcherbuk A. Y., Shcherbuk Y. A., Yanov Yu. K. Intracranial purulent-inflammatory complications of acute and chronic diseases of the ear, nose and paranasal sinuses. SPb, 2018:234. (In Russ.).
19. Shcherbuk Y. A., Zacharov V. I., Shcherbuk A. Y. et al. The influence of burdened premorbid status on the outcomes of treatment of elderly patients with severe traumatic brain injury // Grekov`s Bulletin of Surgery. 2019;178(1):30–33 (In Russ.). Doi: 10.24884/0042-4625-2019-178-1-30-33.
20. Figueroa J. M., Berry K., Boddu J. et al. Treatment strategies for patients with concurrent blunt cerebrovascular and traumatic brain injury // J. Clin. Neurosci. 2021;88:243–250. Doi: 10.1016/j.jocn.2021.03.044.
21. Moskowitz E., Melendez C. I., Dunn J. et al. Long-Term Effects of Decompressive Craniectomy on Functional Outcomes after Traumatic Brain Injury: A Multicenter Study // Am Surg. 2018;84(8):1314–1318.
22. MacDonald S. L. The Incidence of Physiatry-Relevant Complications in Trauma Patients Admitted to an Urban Canadian Trauma Center / S.L. MacDonald, L.R. Robinson // Am. J. Phys. Med. Rehabil. 2019;98(2): 165–168. Doi: 10.1097/PHM.0000000000001021.
23. Dunn M. S., Beck B., Simpson P. M. et al. Comparing the outcomes of isolated, serious traumatic brain injury in older adults managed at major trauma centres and neurosurgical services: A registry-based cohort study // Injury. 2019;50(9):1534–1539. Doi: 10.1016/j.injury.2019.06.012.
24. Vlasov A. Yu., Apaguny A. E., Ulyanchenko M. I., Faridun F. Features of the work of the trauma center of the I level of the GBUZ SK "GKB SMP" of Stavropol: from the beginning of the opening to the present day // Vtoroy Vseros. Congress po travmatologii s mezhdunar. uchastiem «Medicinskaya pomosch pri travmah; novoe v organizacii I tehnologiyah »: sb. tez. SPb: «Chelovek i ego zdorove». 2017:22 (In Russ.).
25. Tulupov A. N., Manukovskiy V. A., Kajanov I. V., Besaev G. M. Experience in providing specialized medical care for closed combined injuries and injuries in the trauma center of the first level «St. Petersburg Research Institute of Ambulance named I. I. Djanelidze» // Mediko-biologicheskie i socialno-psihologicheskie problemi bezopasnosti v chrezvichaynih situaciyah. 2018;(2):51–59 (In Russ.). Doi:10.25016/2541-7487-2018-0-2-51-59.
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Shcherbuk Yu.A., Maday D.Yu., Shcherbuk A.Yu., Donskov V.V., Cherepanova E.V., Tyurin R.V., Leyko D.V. Improving the system of neurotraumatology care in the metropolis for elderly victims with severe traumatic brain injury (on the example of Saint Petersburg). Grekov's Bulletin of Surgery. 2022;181(4):13-19. (In Russ.) https://doi.org/10.24884/0042-4625-2022-181-4-13-19
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