Article

OBJECTIVES: To develop prognostic models for long-term survival in adults with
traumatic brain injury (TBI) and to assess their external validity in 2 independent populations. DESIGN: Survival analysis. SETTING: Post-discharge from
rehabilitation units and long-term follow-up at regional centers. PARTICIPANTS:
Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic Brain Injury
Model Systems (TBIMS) cohort comprised 7365 persons who were admitted to a TBIMS
facility and were assessed at >/=1 years postinjury, and the California
Department of Developmental Services (CDDS) cohort comprised 5116 persons who
sustained a TBI and received long-term services from the CDDS. INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: Survival/mortality. RESULTS: Older age, male
sex, and severity of disability in walking and feeding were significant
predictors of increased long-term mortality rates (all P<.05, both databases).
The CDDS model predicted 623 deaths for persons in the TBIMS cohort, with an
observed-to-expected ratio of .94 (95% confidence interval [CI], 0.87-1.02). The
TBIMS model predicted a total of 525 deaths for persons in the CDDS cohort, with
an observed-to-expected ratio of 1.08 (95% CI, 0.99-1.17). Regression calibration
statistics were satisfactory, and both models ranked survival times well from
shortest to longest (TBIMS: C index, .78; 95% CI, .76-.80; CDDS: C index, .80;
95% CI, .78-.82). CONCLUSIONS: Long-term survival prognosis in TBI is related to
age, sex, and severity of disability. When compared on the basis of these
factors, the survival estimates derived from the TBIMS and CDDS cohorts are found
to be similar. The close agreement between model predictions and actual mortality
rates confirm the external validity of the prognostic models presented herein.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS