Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended

Overview

Journal Neurotrauma Rep

Date 2024 Mar 4

PMID 38435078

Authors

Rabea Iris Pantelatos

Jonas Stenberg

Turid Follestad

Oddrun Sandrod

Cathrine Elisabeth Einarsen

Anne Vik

Toril Skandsen

Affiliations

Soon will be listed here.

Abstract

The aims of this study were (1) to report outcome and change in outcome in patients with moderate and severe traumatic brain injury (mo/sTBI) between 6 and 12 months post-injury as measured by the Glasgow Outcome Scale Extended (GOSE), (2) to explore if demographic/injury-related variables can predict improvement in GOSE score, and (3) to investigate rate of improvement in Disability Rating Scale (DRS) score, in patients with a stable GOSE. All surviving patients ≥16 years of age who were admitted with mo/sTBI (Glasgow Coma Scale [GCS] score ≤13) to the regional trauma center in Central Norway between 2004 and 2019 were prospectively included ( = 439 out of 503 eligible). GOSE and DRS were used to assess outcome. Twelve-months post-injury, 13% with moTBI had severe disability (GOSE 2-4) versus 27% in sTBI, 26% had moderate disability (GOSE 5-6) versus 41% in sTBI and 62% had good recovery (GOSE 7-8) versus 31% in sTBI. From 6 to 12 months post-injury, 27% with moTBI and 32% with sTBI had an improvement, whereas 6% with moTBI and 6% with sTBI had a deterioration in GOSE score. Younger age and higher GCS score were associated with improved GOSE score. Improvement was least frequent for patients with a GOSE score of 3 at 6 months. In patients with a stable GOSE score of 3, an improvement in DRS score was observed in 22 (46%) patients. In conclusion, two thirds and one third of patients with mo/sTBI, respectively, had a good recovery. Importantly, change, mostly improvement, in GOSE score between 6 and 12 months was frequent and argues against the use of 6 months outcome as a time end-point in research. The GOSE does, however, not seem to be sensitive to actual change in function in the lower categories and a combination of outcome measures may be needed to describe the consequences after TBI.

References

Perel P, Arango M, Clayton T, Edwards P, Komolafe E, Poccock S . Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008; 336(7641):425-9. PMC: 2249681. DOI: 10.1136/bmj.39461.643438.25. View

Andelic N, Roe C, Tenovuo O, Azouvi P, Dawes H, Majdan M . Unmet Rehabilitation Needs after Traumatic Brain Injury across Europe: Results from the CENTER-TBI Study. J Clin Med. 2021; 10(5). PMC: 7959119. DOI: 10.3390/jcm10051035. View

Sveen U, Roe C, Sigurdardottir S, Skandsen T, Andelic N, Manskow U . Rehabilitation pathways and functional independence one year after severe traumatic brain injury. Eur J Phys Rehabil Med. 2016; 52(5):650-661. View

Eagle S, Nwachuku E, Deng H, Okonkwo D, Elmer J, Pease M . Applying the Sliding Scale Approach to Quantifying Functional Outcomes Up to Two Years After Severe Traumatic Brain Injury. J Neurotrauma. 2023; 41(11-12):1417-1424. DOI: 10.1089/neu.2023.0258. View

Wilde E, Whiteneck G, Bogner J, Bushnik T, Cifu D, Dikmen S . Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil. 2010; 91(11):1650-1660.e17. DOI: 10.1016/j.apmr.2010.06.033. View

Maas A, Menon D, Adelson P, Andelic N, Bell M, Belli A . Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017; 16(12):987-1048. DOI: 10.1016/S1474-4422(17)30371-X. View

Zelnick L, Morrison L, Devlin S, Bulger E, Brasel K, Sheehan K . Addressing the challenges of obtaining functional outcomes in traumatic brain injury research: missing data patterns, timing of follow-up, and three prognostic models. J Neurotrauma. 2014; 31(11):1029-38. PMC: 4043258. DOI: 10.1089/neu.2013.3122. View

Sigurdardottir S, Andelic N, Roe C, Schanke A . Cognitive recovery and predictors of functional outcome 1 year after traumatic brain injury. J Int Neuropsychol Soc. 2009; 15(5):740-50. DOI: 10.1017/S1355617709990452. View

Gritti P, Zangari R, Carobbio A, Zucchi A, Lorini F, Ferri F . Acute and Subacute Outcome Predictors in Moderate and Severe Traumatic Brain Injury: A Retrospective Monocentric Study. World Neurosurg. 2019; 128:e531-e540. DOI: 10.1016/j.wneu.2019.04.190. View

10.

Whitnall L, McMillan T, Murray G, Teasdale G . Disability in young people and adults after head injury: 5-7 year follow up of a prospective cohort study. J Neurol Neurosurg Psychiatry. 2006; 77(5):640-5. PMC: 2117429. DOI: 10.1136/jnnp.2005.078246. View

11.

Mauritz W, Wilbacher I, Leitgeb J, Majdan M, Janciak I, Brazinova A . One-year outcome and course of recovery after severe traumatic brain injury. Eur J Trauma Emerg Surg. 2016; 37(4):387-95. DOI: 10.1007/s00068-010-0053-6. View

12.

Jennett B, Snoek J, Bond M, Brooks N . Disability after severe head injury: observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psychiatry. 1981; 44(4):285-93. PMC: 490949. DOI: 10.1136/jnnp.44.4.285. View

13.

Edwards P, Arango M, Balica L, Cottingham R, El-Sayed H, Farrell B . Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet. 2005; 365(9475):1957-9. DOI: 10.1016/S0140-6736(05)66552-X. View

14.

Singh R, Choudhri K, Sinha S, Mason S, Lecky F, Dawson J . Global outcome after traumatic brain injury in a prospective cohort. Clin Neurol Neurosurg. 2019; 186:105526. DOI: 10.1016/j.clineuro.2019.105526. View

15.

Hudak A, Caesar R, Frol A, Krueger K, Harper C, Temkin N . Functional outcome scales in traumatic brain injury: a comparison of the Glasgow Outcome Scale (Extended) and the Functional Status Examination. J Neurotrauma. 2005; 22(11):1319-26. DOI: 10.1089/neu.2005.22.1319. View

16.

Andersson E, Rackauskaite D, Svanborg E, Csajbok L, Ost M, Nellgard B . A prospective outcome study observing patients with severe traumatic brain injury over 10-15 years. Acta Anaesthesiol Scand. 2017; 61(5):502-512. DOI: 10.1111/aas.12880. View

17.

Steyerberg E, Wiegers E, Sewalt C, Buki A, Citerio G, De Keyser V . Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet Neurol. 2019; 18(10):923-934. DOI: 10.1016/S1474-4422(19)30232-7. View

18.

Corral L, Ventura J, Herrero J, Monfort J, Juncadella M, Gabarros A . Improvement in GOS and GOSE scores 6 and 12 months after severe traumatic brain injury. Brain Inj. 2008; 21(12):1225-31. DOI: 10.1080/02699050701727460. View

19.

Bossers S, Boer C, Bloemers F, Van Lieshout E, Den Hartog D, Hoogerwerf N . Epidemiology, Prehospital Characteristics and Outcomes of Severe Traumatic Brain Injury in The Netherlands: The BRAIN-PROTECT Study. Prehosp Emerg Care. 2020; 25(5):644-655. DOI: 10.1080/10903127.2020.1824049. View

20.

Jourdan C, Bosserelle V, Azerad S, Ghout I, Bayen E, Aegerter P . Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): results from the PariS-TBI study. Brain Inj. 2013; 27(9):1000-7. DOI: 10.3109/02699052.2013.794971. View