RESUMO
The clinical experience in recent years regarding vocational outcome of patients following traumatic brain injury (TBI) led to the impression of worse outcomes in recent years. A comparative study was therefore conducted between a "control group" of patients who were treated during the years 1980-1985 (n=147), evaluated during 1993 and a "research group" hospitalized between 1998-2001 and evaluated during 2004 (n=247). No significant differences were found between the control and research groups regarding most of the demographic and injury-related parameters. Significant differences were found regarding the length of inpatient rehabilitation stay which was found to be shorter in the "research group" (165 and 117 days respectively, p < 0.0001). More patients in the research group were left with cognitive and behavioral disturbances at the time of discharge (p < 0.0001) and less patients in the research group were able to achieve gainful employment (50.6% and 34.8% respectively, p < 0.0001). On many occasions, recommendations given at the time of discharge were not fulfilled. The compliance for further treatment was quite high regarding physiotherapy (85%) but when it came to cognitive or behavioral treatment the percentage dropped to only about 60%. Patients were not satisfied with the attitudes of their health care providers, especially with regard to health funds and insurance companies. It is concluded that discharge of patients who may physically look fit is premature. The effect of residual cognitive and behavioral disturbances, which, at the end, determine the overall outcome of patients with TBI, is underestimated and treatment is prematurely discontinued, leading to a less successful outcome for these young patients in recent years. It is speculated that any saving in cost due to shortening of the stay in hospital leads to a worse outcome and possible larger compensations due to inability to achieve gainful employment.
