Details

Autor(en) / Beteiligte

• Brooks, Jordan C., PhD, MPH
• Strauss, David J., PhD
• Shavelle, Robert M., PhD
• Paculdo, David R., MPH
• Hammond, Flora M., MD
• Harrison-Felix, Cynthia L., PhD

Titel

Long-Term Disability and Survival in Traumatic Brain Injury: Results From the National Institute on Disability and Rehabilitation Research Model Systems

Ist Teil von

• Archives of physical medicine and rehabilitation, 2013-11, Vol.94 (11), p.2203-2209

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Objectives To document long-term survival in 1-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and FIM as factors in the estimation of survival probabilities; and to investigate the effect of time since injury and secular trends in mortality. Design Cohort study of 1-year survivors of TBI followed up to 20 years postinjury. Statistical methods include standardized mortality ratio, Kaplan-Meier survival curve, proportional hazards regression, and person-year logistic regression. Setting Postdischarge from rehabilitation units. Participants Population-based sample of persons (N=7228) who were admitted to a TBI Model Systems facility and survived at least 1 year postinjury. These persons contributed 32,505 person-years, with 537 deaths, over the 1989 to 2011 study period. Interventions Not applicable. Main Outcome Measure Survival. Results Survival was poorer than that of the general population (standardized mortality ratio=2.1; 95% confidence interval, 1.9–2.3). Age, sex, and functional disability were significant risk factors for mortality ( P <.001). FIM- and DRS-based proportional hazards survival models had comparable predictive performance (C index: .80 vs .80; Akaike information criterion: 11,005 vs 11,015). Time since injury and current calendar year were not significant predictors of long-term survival (both P >.05). Conclusions Long-term survival prognosis in TBI depends on age, sex, and disability. FIM and DRS are useful prognostic measures with comparable statistical performance. Age- and disability-specific mortality rates in TBI have not declined over the last 20 years. A survival prognosis calculator is available online ( http://www.LifeExpectancy.org/tbims.shtml ).