Profiles of TBI Injury Severity as Predictors of Functional Outcomes and Well-being Outcomes

Abstract

<h3>Research Objectives</h3> To identify profiles of traumatic brain injury (TBI) severity and relate profiles to functional and well-being outcomes. <h3>Design</h3> Longitudinal observational study with assessments during acute rehabilitation, discharge, and one year after injury. <h3>Setting</h3> Santa Clara Valley Medical Center (SCVMC) acute inpatient rehabilitation and general community setting. <h3>Participants</h3> Three hundred and seventy-nine individuals [76.8% male; mean(std) age=34.6(16.9) years] in the Traumatic Brain Injury Model Systems at SCVMC with head computed tomography (CT) data. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> At discharge- length of stay, Functional Independence Measure (FIM), and Disability Rating Scale (DRS). One-year post-injury- Glasgow Outcome Scale (GOS), FIM, and Satisfaction with Life Scale (SWLS). <h3>Results</h3> Reults: Latent profile analysis (LPA) was used to identify subgroups with similar patterns across 12 indicators of injury severity, including duration of post-traumatic amnesia, Glasgow Coma Scale, time to follow commands, and head CT variables. LPA identified four latent classes: Class1 (least severe; N=75), Class2 (intermediate; N=124), Class3 (moderate; N=144), and Class4 (most severe; N=27). Younger age, lower education, rural residence, injury in motor vehicle accidents, and earlier injury years were associated with worse severity (ps <.05). Latent classes were related to outcomes. Compared to Class1, hospital stays were longer, FIM scores lower, and DRS scores larger at discharge among individuals in Class3 and Class4 (all ps < .01). One-year post-injury, GOS and FIM scores were significantly lower in Class3 and Class4 than Class1 (ps <.01). FIM scores were also lower among individuals in Class2, compared to Class1 (p=.015). SWLS scores were lower only among individuals in Class3 (p=.036); other comparisons relative to Class1 were not significant. <h3>Conclusions</h3> Meaningful profiles of TBI severity can be identified from acute injury characteristics and may suggest premorbid populations at risk for worse injuries, including younger individuals and those with lower education. Improving classification may help focus on those at elevated risk for severe injury and inform clinical management and prognosis. <h3>Author(s) Disclosures</h3> The authors have no conflicts of interest or financial ties to disclose.