Citation

Brooks JC, Strauss DJ, Shavelle RM, Paculdo DR, Hammond FM, Harrison-Felix CL. Arch. Phys. Med. Rehabil. 2013; 94(11): 2203-2209.

Affiliation

Life Expectancy Project, San Francisco, CA. Electronic address: Brooks@LifeExpectancy.org.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2013.07.005

PMID

23872079

Abstract

OBJECTIVE: To document long-term survival in one-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and Functional Independence Measure (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 one-year survivors of TBI; followed up to 20 years post-injury. Statistical methods include standardized mortality ratios (SMRs), Kaplan-Meier survival curve, proportional hazard regression, and "person-year" logistic regression. SETTING: Post-discharge from National Institute on Disability and Rehabilitation Research-funded TBI Model Systems rehabilitation units. PARTICIPANTS: Population-based sample of 7,228 persons who were admitted to a TBI Model Systems facility and survived at least 1 year post-injury. These persons contributed 32,505 person-years, with 537 deaths, over the 1989 to 2011 study period. INTERVENTIONS: Not Applicable. MAIN OUTCOME MEASURES: Survival. RESULTS: Survival was poorer than that of the general population (SMR=2.1; 95% CI 1.9-2.3). Age, sex, and functional disability were significant risk factors for mortality (p < 0.0001). FIM- and DRS-based proportional hazard survival models had comparable predictive performance (C-index 0.80 vs. 0.80, AIC 11,005 vs 11,015). Time since injury and current calendar year were not significant predictors of long-term survival (both p > 0.05). CONCLUSION: 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 at http://www.LifeExpectancy.org/tbims.shtml.

Language: en