What are the functional consequences after TBI? The SHEFBIT cohort experience.

Objectives: To investigate functional outcome after TBI and identify variables that predict outcome in a multiordinal regression model.

Background: The results of global outcome studies after Traumatic Brain Injury(TBI) differ widely due to differences in outcome measure, attrition to follow-up and selection bias. Outcome information would inform patients/families, guide service development and target high-risk individuals.

Subjects/setting: prospective cohort of 1322 admissions with TBI, assessed by face to face interviews at 1 yr.

Measures: Extended Glasgow Outcome Scale (GOSE) by structured questionnaire.

Results: At 1 year, outcome was determined in 1207(91.3%). Mean age was 46.9(SD17.3); Almost half(49.2%) had mild injury. At one year, 42.9% achieved Good Recovery but GOSE declined in 11.4% of the cohort compared to 10 weeks including 60(4.9%) deaths. In an ordinal logistic regression, increasing TBI severity, etiology (assault), more prominent CT abnormality, past psychiatric history and alcohol intoxication were independent predictors of worse GOSE. A pseudo-R of 0.38 suggested that many unmeasured factors also contribute to TBI outcome. Future work needs to identify other variables that may influence outcome.

Conclusions: In a large TBI cohort, there is still considerable functional disability at 1 year. It may be possible to target high-risk groups for rehabilitation.