Article

OBJECTIVE: To comprehensively describe the temporal patterns of global outcome
after traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems
National Database (TBIMS NDB). DESIGN: Longitudinal prospective cohort study.
SETTING: TBI Model Systems centers. PARTICIPANTS: Patients (N=3870) >/=16 years
of age with moderate or severe TBI enrolled in the TBIMS NDB. INTERVENTIONS: None.
MAIN OUTCOME MEASURE: Glasgow Outcome Scale-Extended (GOS-E).
RESULTS: The
trajectory of the GOS-E scores is best described with a model of quadratic
change, in which scores initially increase and peak approximately 10 years after
the first GOS-E assessment, and then decrease. Change occurs most rapidly in the
initial and final years of the timeline. There was significant variability in
each growth parameter (P<.05). A reduced multilevel model was built, including
all covariates (age at first GOS-E assessment, FIM, race, sex, rehabilitation
length of stay) that related significantly to the growth parameters. An
interactive tool was created to generate individual level trajectories based on
various combinations of covariate values. Results provide an individual level
account of the chronological progression of TBI outcomes, as measured by the
GOS-E. CONCLUSIONS: Individual growth curve analysis is a statistically rigorous
approach to describe temporal change with respect to the GOS-E at the individual
level for participants within the TBIMS NDB. Results indicated that, for
individuals in the TBIMS NDB as a group, functional status as measured by the
GOS-E initially improves, plateaus, and then begins to decline. Factors such as
age at first GOS-E assessment, race, FIM score at rehabilitation admission, and
rehabilitation length of stay were found to influence baseline
GOS-E scores, as
well as the rate and extent of both improvement and decline over time. Additional
research may be required to determine the generalizability of these findings and
the usefulness of this tool for clinical applications.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS