Disability in young people and adults after head injury: 12–14 year follow-up of a prospective cohort

Abstract

Background There is a need to establish how long term outcome evolves after head injury (HI) and factors related to this, to inform opportunities for intervention. Objective To determine late outcome in adults 12e14 years after hospital admission for HI and to examine relationships between injury, early and late factors, and disability. Methods A prospective cohort with HI, whose outcome was reported previously at 1 and 5e7 years after injury, were followed up after 12e14 years. Participants were assessed using structured and validated measures of disability (Glasgow Outcome Scale-Extended), psychological well being, alcohol use and health status. Results Of 219 survivors followed-up at 5e7 years, 34 (15.5%) had died by 12e14 years. Disability remained common in survivors at 12e14 years (51%), as found at 1 and 5e7 years (53%). For those disabled at 1 year, outcome was poor, with 80% dead or disabled at 12e14 years. Older age at injury, a premorbid history of brain illness or physical disability and post-injury low self-esteem and stress were associated with disability at 12e14 years. Disability changed between 5e7 and 12e14 years in 55% of survivors, improving in 23%. Late changes in disability between 5e7 and 12e14 years were associated with self-perceptions of locus of control as being 'powerful others' at 5e7 years. Conclusions Disability is common 12e14 years after hospital admission with a HI. For some there is a dynamic process of change in disability over time that is associated with self-perceptions of control that could be a target for intervention based research.

The Glasgow Outcome Scale — 40 years of application and refinement

“…In those who survive at 1 year, approximately half of patients who had mild, moderate and severe head injuries are categorized as disabled by the GOS at 1 year, 5-7 years and 10-12 years after injury 4,44,45 . Follow-up rates in studies that use the GOSs are high, an observation that holds true for large-scale clinical trials 46 , long term community follow-up studies, and unselected series that include patients with mild head injuries (which often have a relatively low retention at follow-up) 4,44,45 .…”

“…In those who survive at 1 year, approximately half of patients who had mild, moderate and severe head injuries are categorized as disabled by the GOS at 1 year, 5-7 years and 10-12 years after injury 4,44,45 . Follow-up rates in studies that use the GOSs are high, an observation that holds true for large-scale clinical trials 46 , long term community follow-up studies, and unselected series that include patients with mild head injuries (which often have a relatively low retention at follow-up) 4,44,45 . The GOSs also tend to be associated with higher follow-up rates than are other assessments, such as cognitive testing 4,47 , an observation that, at least in part, probably reflects their ease of administration and the range of validated methods of administration (face-to-face, telephone or post) as a community measure (GOS and GOSE) and, more recently, as an inpatient measure (GODS).…”

“…Results of these longitudinal studies indicate that some outcomes remain unchanged, but others are dynamic and can improve or deteriorate even ten years or more after injury 4,35,45,74,75 .…”

Recovery after brain damage: Is there any indication for generalization between different cognitive functions?

“…Whereas the course of recovery after traumatic brain damage has received considerable attention (McMillan, Teasdale, & Stewart, 2012), research concerning recovery due to other etiologies, especially after stroke, is still in its infancy (Rasquin, Welter, & van Heugten, 2013). There are several factors that may play a role for cognitive recovery after brain damage.…”

Serum insulin‐like growth factor‐I levels are associated with improved white matter recovery after traumatic brain injury

“…Many more suffer long‐term cognitive and psychological problems with variable natural history 2. A major pathological hallmark of TBI is diffuse axonal injury (DAI), resulting from shearing forces sustained during the injury 3, 4.…”