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Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury.
Front Neurol. 2019; 10:219.FN

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.

Authors+Show Affiliations

Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.Department of Physical Medicine and Rehabilitation, Sørlandet Hospital, Kristiansand, Norway.Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, VA, United States. Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway.Ikerbasque, Basque Foundation for Science, Bilbao, Spain. BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Barakaldo, Spain.Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30923511

Citation

Forslund, Marit V., et al. "Global Outcome Trajectories Up to 10 Years After Moderate to Severe Traumatic Brain Injury." Frontiers in Neurology, vol. 10, 2019, p. 219.
Forslund MV, Perrin PB, Røe C, et al. Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury. Front Neurol. 2019;10:219.
Forslund, M. V., Perrin, P. B., Røe, C., Sigurdardottir, S., Hellstrøm, T., Berntsen, S. A., Lu, J., Arango-Lasprilla, J. C., & Andelic, N. (2019). Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury. Frontiers in Neurology, 10, 219. https://doi.org/10.3389/fneur.2019.00219
Forslund MV, et al. Global Outcome Trajectories Up to 10 Years After Moderate to Severe Traumatic Brain Injury. Front Neurol. 2019;10:219. PubMed PMID: 30923511.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global Outcome Trajectories up to 10 Years After Moderate to Severe Traumatic Brain Injury. AU - Forslund,Marit V, AU - Perrin,Paul B, AU - Røe,Cecilie, AU - Sigurdardottir,Solrun, AU - Hellstrøm,Torgeir, AU - Berntsen,Svein A, AU - Lu,Juan, AU - Arango-Lasprilla,Juan Carlos, AU - Andelic,Nada, Y1 - 2019/03/14/ PY - 2018/10/08/received PY - 2019/02/20/accepted PY - 2019/3/30/entrez PY - 2019/3/30/pubmed PY - 2019/3/30/medline KW - GOSE KW - brain injury KW - outcome assessment KW - prospective studies KW - rehabilitation SP - 219 EP - 219 JF - Frontiers in neurology JO - Front Neurol VL - 10 N2 - 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. SN - 1664-2295 UR - https://www.unboundmedicine.com/medline/citation/30923511/Global_Outcome_Trajectories_up_to_10_Years_After_Moderate_to_Severe_Traumatic_Brain_Injury_ L2 - https://doi.org/10.3389/fneur.2019.00219 DB - PRIME DP - Unbound Medicine ER -
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