Moderate to Severe ABI

Einarsen et al.

(2018)

Norway

N= 395

Population: 395 individuals with moderate TBI, GCS of 9-13.

Follow-up: 1yr.

Findings: At 1 year, 8% of individuals were severely disabled as measured by the GOS-E. Linear regression modelling showed that older age, lower initial GCS, no day-of-injury alcohol intoxication, subdural hematoma, preinjury disability, and occurrence of hypoxia and/or hypotension were significant predictors of moderate disability or worse (GOS-E ≤6) at 1 year.

Gross & Amsler

(2018)

Switzerland

N= 326

Population: 110 older (≥65yr) and 216 younger (16-64yr) individuals at the time of their TBI.

Follow-up: 1yr.

Findings: There was no significant difference in 1-year outcome between younger and older TBI participants as measured by the GOS, EQ-5D, QOLIBRI, and TOP. However, the two physical oriented subscores on the SF-36 showed significantly lower values in the older group. Further analysis showed poorer outcomes on the QOLIBRI among patients aged greater than 80yr.

Andersson et al.

(2017)

Sweden

N=95

Population: 95 individuals with TBI, GCS ≤8

Follow-up: 1yr and 10-15yr post injury

Findings: There was no significant difference in GOS scores from 1yr and 10-15yr post ABI. Poorer GOS scores were correlated to age at both 1yr (p<0.001), and 10-15yr (p=0.021). At 10-15yr follow-up 70% of patients reported mental fatigue. From first to second follow-up the TBI group had significantly higher rates of mortality (p<0.001, p<0.001) compared to healthy controls.

 Novack et al.

(2000)

USA

N=72

Population: 72 individuals with TBI; >50% severe injury.

Follow-up: 6 and 12mo post injury.

Findings: For individuals with severe TBI, driving status improved only marginally from 6 mo (n=11) to 12mo (n=16) (p=0.05); the total number of individuals with >20 hr/wk employment increased from 1 (2.0%) at 6mo to 5 (10.2%) at 12mo; and a trend towards increased productive activities was observed (8.2% at 6mo versus 16.8% at 12mo, p=0.04).

 Malec et al.

(1993)

USA

N=29

Population: 29 individuals with ABI (TBI=20) participating in post-acute rehabilitation. Mean age at admission=33.1yr; mean time post injury=1463.9 days.

Follow-up: 1yr (n=21).

Findings: Eighty-six percent of patients were living with no supervision compared to 48% on admission. 48% of patients were in an independent work placement and 29% were unemployed.

 Cope et al.

(1991)

USA

N=145

Population: 145 individuals with ABI (TBI=113) admitted to post-acute rehabilitation; mean age=35yr; mean time post injury=448 days; mean disability rating score=6.03.

Follow-up: 6, 12, and 24mo post discharge.

Findings: From admission to follow-up there was an increase in residence at home (44.8% to 69.7%), an increase in competitive employment or academic involvement (5.6% to 34.5%), a decrease in ‘no productive activity’ (92.3% to 27.6%), and an increase in the percentage of patients independent throughout a 24hr period (25% to. 78.6%). All differences were significant (p<0.0001).

Severe ABI

Beck et al.

(2018)

Australia

N=1966

Population: 1966 individuals with severe TBI.

Follow-up: 6mo post-injury.

Findings: A majority of individuals had an unfavorable outcome on the GOS-E (</=4) at 6mo post-injury (70%). After adjusting for confounders, there was no change in functional outcomes (p=0.35) and no change in odds of death (GOS-E=1; p=0.08) after severe TBI between 2006 and 2015 in a mature trauma system.

Bonow et al.

(2018)

Argentina

N=550

Population: 550 individuals with severe TBI in lower and middle income countries.

Follow-up: 6mo post-injury.

Findings: A majority of individuals had an unfavorable outcome on the GOS-E (</=4) at 6mo (66%). Higher GCS motor and epidural hematoma were associated with higher scores on the GOS-E at 6mo. Advanced age and cisternal effacement were associated with a lower GOS-E at 6mo. Study site and race (p<0.05) significantly predicted outcome at 6 months, in some cases outweighing clinical variables such as hypotension and pupillary exam.

 Mills et al.

(1992)

USA

N=42

Population: 42 patients with TBI; GCS score <9.

Follow-up: 6mo (n=32), 12mo (n=13), and 18mo (n=18) post discharge from a community cognitive rehabilitation program.

Findings: At 6mo follow-up, 87.5% of patients maintained or improved their status in the home and community, and 90% maintained or improved their status in leisure and vocational function. These gains were maintained or improved at a follow-up of 12 and 18mo.