Devenir et qualité de vie à trois ans dans une cohorte de patients traumatisés crâniens graves

Abstract

Objectives: The late outcome of patients with severe traumatic brain injury (STBI) has been investigated by measuring deficits, disability and social handicap, but their quality of life (QOL) has been less evaluated, and not by a direct analysis of the subjective patient “and relatives” QOL. The aim of this study was to investigate this outcome and the QOL, with its predictive factors, 3 years after STBI, in a homogenous cohort of patients. Material and methods: We selected all adult patients from the Lille area (north of France) admitted in the CHU in 1995 following STBI. Each was evaluated at home, in the presence of a close relative, using the EBIS document. This one investigates the medical history, initial status and late outcome, as well as the subjective QOL of patients (evaluated by the patient and by a close relative: 0-10 on an analogical visual scale) and close relatives. Relationships between possible explanatory factors and QOL were analysed using correlation tests. Results: Among the 33 patients, 23 survived at three years. The mean initial GCS score was of 5,6/15 and the mean coma duration of 18.5 days. At three years, physical deficits were usually discrete, intellectual deficits more important and the emotional and behavioural problems even more severe. The GOS was of 6 in one patient, 4–5 in seven, 2–3 in seven and 0–1 in eight. Dependence in advanced activities was more sever than in elementary activities. The subjective QOL of patients was discretely lower ( m = 5,48/10) than that estimated by close relatives ( m = 5,91). The relatives QOL was similarly reduced ( m = 5,45). The factors most influencing the patients QOL were the cognitive and behavioural problems and the dependence in the advanced activities and the GOS for the patients QOL, and the behavioural problem and the dependence in advanced activities for the relatives QOL. Conclusion: The reduction of the patients “and relatives” QOL was parallel at three years. Emotional and behavioural problem as well as the dependence in advanced activities mainly explained these QOL.