Mild traumatic brain injuries: the impact of early intervention on late sequelae. A randomized controlled trial.

Background: Positive results from early clinical intervention of mild traumatic brain injury (MTBI) patients by rehabilitation specialists have been reported. Various treatments have been used, but few controlled studies are published. We hypothesised that early rehabilitation of selected MTBI patients would reduce long term sequelae.

The new Swedish Post-Concussion Symptoms questionnaire: a measure of symptoms after mild traumatic brain injury and its concurrent validity and inter-rater reliability.

Objective: To study the concurrent validity and the inter-rater reliability of the Post-Concussion Symptoms Questionnaire.

Design: The approach was to study the concurrent validity of the Post-Concussion Symptoms Questionnaire when used as an interview questionnaire compared with a self-report questionnaire administered by the patients. The inter-rater reliability was also studied when 2 different raters administered the Post-Concussion Symptoms Questionnaire interview.

Quality of life and post-concussion symptoms in adults after mild traumatic brain injury: a population-based study in western Sweden.

Objectives: To study quality of life and subjective post-concussion symptoms in adults (16-60 years) with a mild traumatic brain injury (MTBI) 3 months and 1 year after injury.

Methods: Of a total of 489 patients 173 responded to questionnaires at 3 months and at 1 year, including the SF-36 health-related quality of life survey, which is a standardized measure validated for Swedish conditions. Post-concussion symptoms were rated as either existing or non-existing in a 21-item checklist [a modified version of Comprehensive Psychopathological Rating Scale (CPRS)].

Epidemiology of traumatic brain injury: a population based study in western Sweden.

Background: This study on traumatic brain injury (TBI) is based on prospective and retrospective population based data from a head injury register in Borås.

Methods: Data was collected from the hospital emergency unit, the discharge register, the regional neurosurgical clinic and the coroner's records during 1 year. This district is mixed urban and rural with a population of 138 000.

Quantitative EEG analysis as a supplement to the clinical coma scale RLS85.

Background: The aim of the study was to investigate the correlation between EEG indicators and clinical scores based on the RLS85 (Reaction Level Scale 85) in comatose patients. The results of a simple visual assessment of the EEG, using an arbitrary scale with typical EEG patterns, were compared with those obtained by quantitative electroencephalography (qEEG).

Method: The RLS85 scores were examined in 34 patients with impaired consciousness due to brain tumours, vascular lesions or head injuries.

[Operational manual of the reaction level scale (RLS85)].

The Reaction Level Scale (RLS85) is a range scored coma scale (8 levels) for the assessment of responsiveness in patients with acute brain disorders. Its feasibility in clinical practice and for research studies has been verified in a multicentre study and by comparison with other current coma scales. Range scoring and absence of pseudoscoring are its most significant advantages over the other current scales.

[A new reaction level scale is recommended in Sweden].

Assessment of the reaction level is the single most important investigation in patients with acute cerebral disorders. The Reaction Level Scale, RLS-85, a recently developed and scientifically based method, is recommended for introduction in Sweden.

A comparison of the Glasgow Coma Scale and the Reaction Level Scale (RLS85).

The Glasgow Coma Scale (GCS) and the Reaction Level Scale (RLS85) were compared for rating neurosurgical patients in regard to ranking order of deficit severity, interobserver variability, and coverage for relevant factors. Four physicians, four registered nurses, and four assistant nurses performed 72 pairwise ratings on 47 neurosurgical patients. The rank correlation between the GCS sum score and the RLS85 was -0.

Current reporting of responsiveness in acute cerebral disorders. A survey of the neurosurgical literature.

One hundred sixty-six papers published in seven neurosurgical journals from 1983 through 1985 have been surveyed to determine the methods used for assessment of overall patient responsiveness in acute cerebral disorders (coma grading). Fifty-one different coma scales or modifications were found. The Glasgow Coma Scale (GCS) sum score (that is, the sum of the scores of the individual eye, verbal, and motor scales) dominated (54%), and was used in 73 (76%) of 96 of the head-injury studies; in 56 (77%) of these 73 studies it was the single method of grading neurological status.

The Reaction Level Scale (RLS85). Manual and guidelines.

The Reaction Level Scale (RLS85) is a "coma scale" for the direct assessment of overall reaction level in patients with acute brain disorders. It is devised for reliable use even in the management of patients who are difficult to assess, such as intubated patients and patients with swollen eyelids. We here present the manual of the RLS85 and the guidelines for its use.

Assessment of responsiveness in acute cerebral disorders. A multicentre study on the reaction level scale (RLS 85).

A new scale for assessment of overall responsiveness, the Reaction Level Scale (RLS 85), which has been shown to have better reliability than the Glasgow Coma Scale (GCS), has been tested in four neurosurgical departments regarding inter-observer agreement and coverage i.e. the proportion of patients that could be assessed by the scale.

A new model of concussive brain injury in the cat produced by extradural fluid volume loading: II. Physiological and neuropathological observations.

This study examined physiological and histopathological changes in the cat produced by a new experimental fluid injury device. Spontaneously breathing (N = 14) and artificially ventilated (N = 45) cats were subjected to systemically varied magnitudes of fluid percussion brain injury. Within certain injury ranges, increasing magnitudes of fluid percussion injury produced increasing durations of apnea, as well as greater transient increases in mean arterial blood pressure, intracranial pressure and cerebral perfusion pressure.

A new model of concussive brain injury in the cat produced by extradural fluid volume loading: I. Biomechanical properties.

This study presents a new device for producing experimental, concussive head injury together with a detailed description of biomechanical features of fluid percussion brain injury in the cat. Anaesthetized cats were subjected to multiple (N = 3) or single injuries (N = 87). The variables studied in repeated injury experiments included the volume of fluid injected intracranially, rate of fluid flow, and the associated pressure transients recorded extracranially in the injury device and intracranially at supratentorial and infratentorial sites.

Assessment of responsiveness in head injury patients. The Glasgow Coma Scale and some comments on alternative methods.

The last twelve years history of coma scaling, i.e. reaction level scaling is reviewed.

Resources, distribution and management levels of head injury patients; place of CT-scanning.

The task for the medical profession is to diagnose, to treat, to evaluate results of the management and to deliver information about the management to those who are responsible for the regional planning of head injury care and preventive work. The impact of CT scanning on diagnoses and distribution on different levels of managements is discussed. These considerations are related to the degree of severity of the patient's symptoms early after the accident.

Experimental models of head injury.

Experimental research in studies of head injury may be directed along theoretical, mechanical and experimental animal and clinical lines. The parameter of the results compared may thus be the mechanics of skull or the skull contents, pathophysiological changes or pathomorphological lesions. Due to the variation of the daily accidents and resulting injuries each series of problems must be studied with suitable technique.

Experimental brain damage from fluid pressures due to impact acceleration. 1. Design of experimental procedure.

The significance of the intracranial acceleration pressure pattern at impact to the intact skull in production of brain damage is discussed particularly as regards the contre-coup pressures. Sudden pressure changes within the cranial cavity of the rabbit were studied by means of a new impact acceleration model. The rabbit skull was connected with a cylinder.

Experimental brain damage from fluid pressures due to impact acceleration. 3. Morphological observations.

"Contre-coup" lesions occurring particularly in the frontal and temporal lobes following head injury have been claimed to be caused by sudden negative pressure transients, as part of the "contre-coup" end pressures occurring in the brain tissue at an occipital impact. With a new experimental model such impact acceleration pressure (near-1 atm) could be generated in the rabbit brain through a parietal opening. Resulting morphological changes were evaluated with various microscopical methods, including Evan's blue-albumin technique for observations on vascular permeability changes.

Experimental brain damage from fluid pressures due to impact acceleration. 2. Pathophysiological observations.

The significance of the intracranial acceleration pressure pattern at impact to the intact skull in production of brain damage is discussed, particularly as regards the contre-coup pressures. A rigid fluid-filled cylinder was connected to the skull cavity of rabbits; the cylinder was impacted and the intracranial contents acted as a contre-coup end. The pressure pattern was also modified by injection of small quantified air volumes.