Traumatic Injuries to the Central Nervous System: Clinical Epidemiology and Treatment Outcomes among the Severely Injured

This thesis explores the clinical epidemiology of patients who have suffered traumatic brain injuries (TBI) and traumatic spinal cord injuries (TSCI). Initially, it addresses the rising clinical significance of TBI in hospitals, highlighting a shift in trauma-related morbidity and mortality toward TBI. The studies presented support the notion that TBI represents the last frontier in improving acute-phase trauma outcomes, akin to the successes achieved in managing other morbidities such as exsanguination, multi-organ failure, and acute respiratory failure following thoracic injuries.
Furthermore, the research examines how TBI mortality is commonly associated with the withdrawal of life-sustaining treatment—a phenomenon observed in multiple hospitals in the Netherlands but seldom described in existing literature. Post-acute phase outcomes are also analyzed, revealing an aging—and still predominantly male—demographic characterized by a high degree of severe incapacitation or death, yet a very small proportion of patients remain in a prolonged unconscious state. In contrast, pediatric outcomes tend to be more favorable, with the vast majority of young patients achieving full recovery or experiencing only minor impairments after the acute phase.
The thesis identifies and critiques flaws in tools commonly used for classifying and comparing brain injuries, such as the Abbreviated Injury Scale for the head and the Glasgow Coma Scale. The second part of the thesis focuses on TSCI, a considerably rarer yet equally devastating condition for patients and their communities. Trends indicate a stable incidence rate but a higher proportion of incomplete cervical injuries within an aging population.
Comprehensive discussions range from prehospital management to long-term rehabilitation outcomes, showcasing meaningful improvements in neurological function following rehabilitation. Lastly, the thesis delves into end-of-life discussions among TSCI patients—a topic with minimal representation in current literature—and explores the motivations for these discussions within a clinical context. This highlights the profound complexity inherent in this critical aspect of neurological care.