Global Outcome Trajectories After TBI Among Survivors and Nonsurvivors

Abstract

Objective To compare long-term functional outcome trajectories of individuals with traumatic brain injury (TBI) who survive with those who expire more than 5 years postinjury, using individual growth curve analysis. Design Secondary analysis of data from a multicenter longitudinal cohort study. Setting Acute inpatient rehabilitation facilities that are current or former TBI Model Systems. Participants Individuals 16 years and older with a primary diagnosis of TBI. Main Outcome Measures Glasgow Outcome Scale–Extended; Disability Rating Scale. Results Individuals in the TBI Model Systems who expire several years after injury demonstrate worse functional status at baseline and a steeper rate of decline over time as measured by both the Glasgow Outcome Scale–Extended and the Disability Rating Scale. There was significant variability in each growth parameter (P < .05) for both instruments. A reduced model was built for each outcome, including all covariates that related significantly to the growth parameters. An interactive tool was created for each outcome to generate individual-level trajectories based on various combinations of covariate values. Conclusion Individuals with TBI who die several years after injury demonstrate functional trajectories that differ markedly from those of survivors. Opportunities should be sought for health management interventions to improve health and longevity after TBI.

Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury

“…Contrary to our hypothesis, the HLM of the quadratic GOSE score trajectories showed a significant change over time, with an initial increase and then decrease in GOSE scores up to 10 years after injury. These findings are partly consistent with two larger US studies looking at GOSE trajectories up to 20 years after TBI ( 18 , 19 ), which found initial improvement in functional status before a peak, and a decline in GOSE scores. However, the decline started after the 10-year follow-up.…”

“…A Swedish study ( 16 ) reported no significant difference in GOS outcome between 1 year and 10–15 years in survivors after severe TBI; similarly, a recent Norwegian study ( 17 ) found stable global functioning between 10 and 20 years after moderate to severe TBI. These Scandinavian findings of stable levels of disability are contrary to the findings in two large TBIMS studies ( 18 , 19 ) that reported initial improvement in functional status up to approximately 10 years after injury, followed by a peak and a decline in GOSE scores (i.e., increasing disability).…”

“…There is increasing evidence for the factors that predict functional outcome after TBI; age ( 10 , 15 , 16 , 18 – 26 ), sex ( 20 , 27 ), education ( 21 , 28 – 30 ), pre-injury employment ( 15 , 20 , 28 , 31 ), race ( 18 , 32 , 33 ), history of alcohol abuse prior to injury ( 20 , 34 ), presence of intracranial lesions ( 25 , 35 – 37 ), acute Glasgow Coma Scale (GCS) score ( 25 , 37 ), duration of post-traumatic amnesia (PTA) ( 15 , 29 ), duration of hospitalization and rehabilitation stays ( 18 , 19 ), executive function and memory problems ( 14 , 21 , 29 , 30 , 38 ), and mood disorders ( 14 , 21 , 29 , 34 , 39 , 40 ). However, the findings of the predictive power of these factors are mixed, partly due to methodological differences between the studies.…”

Nurses’ Beliefs About Caring for Patients With Traumatic Brain Injury

“…Survey development. Survey items are based in part on evidence-based clinical guidelines published by the American Association of Neuroscience Nurses (American Association of Neuroscience Nurses, 2008) and in part on the broader TBI outcomes literature (Corrigan et al, 2007;Dams-O'Connor, Pretz, Billah, Hammond, & Harrison-Felix, 2015;Lunney, McGuire, Endozo, & McIntosh-Waddy, 2010;Saban, Smith, Collins, & Pape, 2011). The first draft of survey items generated for the PBIS was distributed to five registered nurses, a PhD-prepared nurse, a physician, and a statistician.…”

Estimating minimal clinically important differences for two scales in patients with chronic traumatic brain injury

“…The estimated global prevalence of chronic impairments secondary to TBI was 55.5 million cases in 2016 2 . In the U.S. alone, over 2.7 million TBIs occur each year, leading to approximately 288,000 TBI-related hospitalizations 3 and resulting in long-term disability among both civilian 4 and military 5 populations. Residual motor deficits in the chronic phase of TBI are common and can be especially disabling.…”