Article

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).
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS