evere traumatic brain injury (TBI), a leading cause of death and disability worldwide, 1 is a particularly important societal issue because of its high economic and personal cost. 2 Australian studies have found acute mortality rates of 30%-35% during the first 6 months after severe TBI. 3-5 Recent Australian estimates on the lifelong economic cost of moderate-to-severe TBI assumed that "patients surviving year 1 [postinjury] reverted to the mortality risk for the general population". 6 However, further data are required to determine the accuracy of this assumption and to improve the robustness of future modelling. The only Australian investigation examining late (ie, greater than 1 year) all-cause mortality for people with severe TBI involved a singlecentre cohort study of 476 patients undergoing rehabilitation in New South Wales. 7 The standardised mortality ratio (SMR)-the ratio of observed mortality in the study group compared with that expected of an age-and sex-matched populationafter discharge indicated a fourfold increase in mortality; this ratio is higher than international long-term mortality estimates, which range from 1.1 to 3.1. 3,8-14 An increased understanding of risk factors associated with long-term mortality is important for informing clinical management. Current knowledge, predominantly from overseas studies, has identified increasing age, 1,7,10,15-17 male sex, 10,17 a history of psychiatric illness, 7,8,11 alcohol and drug misuse, 11 epilepsy, 9,13,18 and functional dependence 12,13,17 as important variables. Studies suggest that post-TBI death rates are equivalent to those of the general population for some diseases (eg, neoplasia), while mortality rates from other causes (eg, respiratory illnesses, aspiration pneumonia) are significantly elevated. Here we further investigate these issues in an Australian data linkage study of people with severe TBI who were discharged from the three adult inpatient units of the NSW Brain Injury Rehabilitation Program (BIRP) in metropolitan Sydney. The study aimed to: (i) determine the long-term all-cause mortality pattern for this inception cohort; (ii) identify associated risk factors; and (iii) examine mortality rates for specific causes of death. Methods After obtaining approval from the appropriate local institutional ethics committees, we searched databases and medical records to identify consecutive rehabilitation admissions of patients with TBI since the NSW BIRP commenced on 1 January 1990. 19,20 The resultant inception cohort was de ri v e d f ro m t hi s i nt e grat e d , statewide, specialist inpatient and community-based rehabilitation program for people who had sustained a severe TBI. Admissions were screened against the following inclusion criteria: age 16-70 years at time of injury; primary BIRP admission; severe TBI (Glasgow Coma Scale score < 9 and/ or duration of post-traumatic amnesia > 1 day 21); and discharged alive before 1 October 2007. This date was selected to coincide with introduction of the Lifetime Care and Support Scheme for ad...

This trial provides initial evidence for the efficacy of a psychological intervention in reducing hopelessness among long-term survivors with severe TBI.

An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements.