Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees versus Non-Attendees

Abstract

This investigation describes the relationship between TBI patient demographics, quality of life outcome, and functional status outcome among clinic attendees and non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended our TBI clinic and 167 did not attend. All were telephone surveyed using the Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury (QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk factors for GOSE and QOLIBRI outcomes, we created multivariable regression models employing covariates of age, injury characteristics, clinic attendance, insurance status, post-discharge rehabilitation, and time from injury. Compared with those with severe TBI, higher GOSE scores were identified in individuals with both mild (odds ratio [OR]=2.0; 95% confidence interval [CI]: 1.1-3.6) and moderate (OR=4.7; 95% CI: 1.6-14.1) TBIs. In addition, survivors with private insurance had higher GOSE scores, compared with those with public insurance (OR=2.0; 95% CI: 1.1-3.6), workers' compensation (OR=8.4; 95% CI: 2.6-26.9), and no insurance (OR=3.1; 95% CI: 1.6-6.2). Compared with those with severe TBI, QOLIBRI scores were 11.7 points (95% CI: 3.7-19.7) higher in survivors with mild TBI and 17.3 points (95% CI: 3.2-31.5) higher in survivors with moderate TBI. In addition, survivors who received post-discharge rehabilitation had higher QOLIBRI scores by 11.4 points (95% CI: 3.7-19.1) than those who did not. Survivors with private insurance had QOLIBRI scores that were 25.5 points higher (95% CI: 11.3-39.7) than those with workers' compensation and 16.8 points higher (95% CI: 7.4-26.2) than those without insurance. Because neurologic injury severity, insurance status, and receipt of rehabilitation or therapy are independent risk factors for functional and quality of life outcomes, future directions will include improving earlier access to post-TBI rehabilitation, social work services, affordable insurance, and community resources.

Post-traumatic stress disorder and self-reported outcomes after traumatic brain injury in victims of assault

“…Although evidence suggests that subjects with more severe injuries suffer worse cognitive and social functioning [38,39], this does not necessarily reflect satisfaction with daily functioning. Like ours, some studies found no connection between initial post-injury GCS and HRQoL [35], but others have found an inverse relationship: two studies demonstrated that, according to GCS, mild TBI patients experienced worse HRQoL than severe TBI [40,41], while increased coma length has also been shown to predict better long-term HRQoL [42]. This fits with our finding that patients with a severe Marshall classification reported more symptoms of PTSD: this effect could be explained by more severe injuries resulting in more peri-trauma amnesia, which has a protective effect against PTSD [43].…”

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

“…[15] A recent study suggested that the relatively worse outcome for patients with mTBI, when compared to moderate TBI, is explained by sickness awareness [27]; patients with mTBI are more aware of cognitive and behavioural disabilities and are therefore less satisfied with their outcome in comparison to more severely injured patients, who might be less aware of their problems. These mechanisms could also explain the unfavourable outcome in one in five of non-hospitalized patients; the awareness of their disabilities in combination with expectation of full recovery, which causes dissatisfaction with current levels of functioning.…”

Sleep Features on Continuous Electroencephalography Predict Rehabilitation Outcomes After Severe Traumatic Brain Injury

“…Participation in rehabilitation is imperative toward favorable long-term outcomes after TBI. 28 As sleep plays an important role in memory consolidation, synaptic plasticity, and neurogenesis (all processes relevant to recovery of neuronal function after injury), sufficient quality and quantity of sleep are critical during the rehabilitation process. 29 Furthermore, poor nighttime sleep is associated with excessive daytime sleepiness, fatigue, and anxiety, which are barriers to optimal participation in rehabilitation therapies.…”