Long-Term Functional Outcome and Quality of Life in Long-Term Traumatic Brain Injury Survivors

Abstract

Early functional outcome assessments of traumatic brain injury (TBI) survivors may underestimate the long-term consequences of TBI. We assessed long-term temporal changes in functional outcome and quality of life in intensive care unit-managed long-term TBI survivors. This prospective, longitudinal study included 180 patients admitted to a single university hospital during 2000-2002 alive at 15 years post-TBI. Baseline characteristics, including imaging information, were collected. Functional outcome was assessed early (6-24 months) and late (15 years) using the Glasgow Outcome Scale (GOS) and the extended GOS (GOSE). Quality of life was measured at 15 years using the EuroQol Five Dimensions Five Levels (EQ-5D-5L) questionnaire. GOS and GOSE were dichotomized into favorable and unfavorable outcome. An index score was computed for EQ-5D-5L results at 15 years by a standardized valuation protocol. Of 180 patients, 118 replied to 15-year questionnaires. Median age at time of injury was 34 years (interquartile range, 19-45). Using the GCS to assess TBI severity, 67% had a moderate-to-severe TBI. Ninety-seven percent had favorable early functional outcome, and 72% had late favorable functional outcome. Logistic regression found higher age, lower GCS, and Marshall CT III to significantly predict late unfavorable functional outcome. Higher age and Marshall CT III were significant predictors of functional outcome deterioration. Median EQ-5D-5L index score for all patients was 0.88 (0.66-1.00) and correlated positively with GOSE. Most long-term TBI survivors with early favorable outcome also have late favorable functional outcome. Higher age and diffuse brain injury are associated with neurological deterioration. Quality of life was strongly linked to functional outcome.

Keywords: functional outcome; outcome; prognosis; quality of life; traumatic brain injury.

FIG. 1.

Flowchart demonstrating patients replying to functional outcome and quality-of-life surveys. ICU, intensive care unit; GOSE, Glasgow Outcome Scale-Extended; TBI, traumatic brain injury.

FIG. 2.

Distribution of outcomes at different time-points of measurement. Circles represent the number of patients in each outcome category. Arrows represent the number of patients moving between outcome categories. Data were collected as shown on the right. In the left figure, the good recovery, moderate disability, and severe disability brackets of the GOSE have been combined into corresponding GOS categories. GOS, Glasgow Outcome Scale; GOSE, Glasgow Outcome Scale-Extended.

FIG. 3.

Relationship between EQ-5D-5L index scores and GOSE at 15 years. Error bars represent 95% confidence intervals (CI). Mean index scores generally increased along with the GOSE. GOSE 3 mean 0.50 (SD, 0.32), GOSE 4 mean 0.66 (SD, 0.21), GOSE 5 mean 0.60 (SD, 0.30), GOSE 6 mean 0.77 (SD, 0.22), GOSE 7 mean 0.82 (SD, 0.23), GOSE 8 mean 0.97 (SD, 0.52). EQ-5D-5L, EuroQol Five Dimensions Five Levels; GOSE, Glasgow Outcome Scale-Extended; SD, standard deviation.