Abstract
Aims: Based on important predictors, global functional outcome after traumatic brain injury (TBI) may vary significantly over time. This study sought to: (1) describe changes in the Glasgow Outcome Scale–Extended (GOSE) score in survivors of moderate to severe TBI, (2) examine longitudinal GOSE trajectories up to 10 years after injury, and (3) investigate predictors of these trajectories based on socio-demographic and injury characteristics.Methods: Socio-demographic and injury characteristics of 97 TBI survivors aged 16–55 years were recorded at baseline. GOSE was used as a measure of TBI-related global outcome and assessed at 1-, 2-, 5-, and 10-year follow-ups. Hierarchical linear models were used to examine global outcomes over time and whether those outcomes could be predicted by: time, time*time, sex, age, partner relationship status, education, employment pre-injury, occupation, cause of injury, acute Glasgow Coma Scale score, length of post-traumatic amnesia (PTA), CT findings, and Injury Severity Score (ISS), as well as the interactions between each of the significant predictors and time*time.Results: Between 5- and 10-year follow-ups, 37% had deteriorated, 7% had improved, and 56% showed no change in global outcome. Better GOSE trajectories were predicted by male gender (p = 0.013), younger age (p = 0.012), employment at admission (p = 0.012), white collar occupation (p = 0.014), and shorter PTA length (p = 0.001). The time*time*occupation type interaction effect (p = 0.001) identified different trajectory slopes between survivors in white and blue collar occupations. The time*time*PTA interaction effect (p = 0.023) identified a more marked increase and subsequent decrease in functional level among survivors with longer PTA duration.Conclusion: A larger proportion of survivors experienced deterioration in GOSE scores over time, supporting the concept of TBI as a chronic health condition. Younger age, pre-injury employment, and shorter PTA duration are important prognostic factors for better long-term global outcomes, supporting the existing literature, whereas male gender and white collar occupation are vaguer as prognostic factors. This information suggests that more intensive and tailored rehabilitation programs may be required to counteract a negative global outcome development in survivors with predicted worse outcome and to meet their long-term changing needs.
Highlights
Traumatic brain injury (TBI) remains one of the main causes of life years lost due to disability or death [1, 2]
Two-thirds of the participants had severe TBI according to Glasgow Coma Scale (GCS) score, whereas about half of the participants were classified as having more severe intracranial
The findings provide insight in which TBI survivors face an increased risk of deterioration of global functioning over time, with the possibility of initiating tailored rehabilitation programs to attempt to counteract this development and to meet the long-term changing needs of this population
Summary
Traumatic brain injury (TBI) remains one of the main causes of life years lost due to disability or death [1, 2]. The level of disability and global neurological functional outcome following TBI is commonly measured with the Glasgow Outcome Scale (GOS) or its extended version (GOSE) [5, 6]. Both summarize the overall impact of TBI on function, independence and participation. Ponsford et al [12] assessed GOSE scores using a cross-sectional design approximately 10 years after complicated mild to severe TBI, and found that 52% of individuals had good recovery, 44% had moderate disability and 5% had severe disability
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