Predicting health-related quality of life 2 years after moderate-to-severe traumatic brain injury

Abstract

Aims -To describe health-related quality of life (HRQL) 2 years after moderate-to-severe traumatic brain injury (TBI) and to assess predictors of HRQL. Materials and methods -A prospective cohort study of 91 patients, aged 16-55 years, admitted with moderate-tosevere TBI to a trauma referral centre between 2005 and 2007, with follow-up at 1 and 2 years. Mean age was 31.1 (SD = 11.3) years, and 77% were men. Injury severity was evaluated by the Glasgow Coma Scale (GCS), head CT scan (using a modified Marshall Classification), Injury Severity Score (ISS) and post-traumatic amnesia (PTA). The Functional Independence Measure (FIM), Community Integration Questionnaire (CIQ), Beck Depression Inventory (BDI) and Medical Outcomes 36-item Short Form Health Survey (SF-36) were administered at follow-up visits. The main outcome measures were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36. Results -HRQL appears to be relatively stable between 1 and 2 years after injury. In the multivariate linear regression, younger age (b = À0.20, P = 0.032), more severe TBI (b = 0.28, P = 0.016), more severe overall trauma (b = 0.22, P = 0.026), higher levels of community integration (b = 0.36, P = 0.019) and higher positive change in PCS scores from 1 to 2 years (b = 0.41, P < 0.001) predicted better self-reported physical health 2 years post-TBI. Lower scores for depression (b = À0.70, P < 0.001) and a higher positive change in MCS scores (b = 0.62, P < 0.001) predicted better self-reported mental health. Conclusions -Future interventions should focus on aspects related to HRQL that are more easily modified, such as physical functioning, home and social integration, productivity, and mental and emotional status.

Patient reported outcome in posttraumatic pituitary deficiency: results from The Danish National Study on posttraumatic hypopituitarism

“…Although controversies may exist concerning the disabilities associated with mild TBI (18), it is generally agreed that survivors of moderate-to-severe TBI are at increased risk of various degrees of permanent disability. Our cohort included patients with mild, moderate, and severe TBI and still showed QoL impairment, sleep disturbances, fatigue, depression, and sexual dysfunction at comparable rates to previous reports (19).…”

Relationship between quality-of-life after 1-year follow-up and severity of traumatic brain injury assessed by computerized tomography

“…However, the relationship between CT scan findings and QoL has been poorly studied, which explains the reason for this report. Some studies demonstrate this relationship [12,13], although these deal with patients in less serious situations than those admitted to the ICU or with smaller groups of patients or they do not consider and examine every single category of the Marshall classification or the relationship between CT and QoL in depth, as has been done in this study. This study analysed these aspects in a sample of ICU patients which was large enough to study QoL in most categories of the Marshall classification.…”

“…The association between lesions found on CT and mortality is widely known and has been documented in many studies [3,[8][9][10][11], as well as the association with other factors such as the initial Glasgow Coma Scale (GCS), APACHE II, ISS. The association between the Marshall CT classification and mortality and functional outcomes has been described extensively in the literature [3,[11][12][13], but the relationship between cranial CT findings and QoL has been poorly studied.…”

“…Recently, Forslund et al [13] carried out a study involving a sample of 91 patients with moderate-to-severe TBI. Their results showed poorer QoL at 2 years in patients who had more serious findings on cranial CT during the first 24 hours after admission.…”

Health-related quality of life after mild, moderate and severe traumatic brain injury: Patterns and predictors of suboptimal functioning during the first year after injury

“…In contrast to the GOSE, HRQL measures enable comparison of health outcome after TBI with other diseases and the general population, and their outcome in terms of an health status on a scale from 0 (death) to 1 (perfect health) scale can be used in economic evaluations. Research has shown that even years after injury, many TBI patients still report significantly lower HRQL than the general population [1,2,[11][12][13][14]. Most studies however, focus on recovery after mild [15][16][17] or moderate and severe [1,12,13,18,19] TBI.…”