Predictors of long-term outcome after severe traumatic brain injury

• Main Author: Ulfarsson, Trandur
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: 2013
• Subjects: Severe Traumatic brain injury; Prognosis; Hypopituitarism; Pre-morbid; Rehabilitation; Health Facility Planning; Long-term outcome; Functioning; Quality of life; Survival analysis; Iceland
• Online Access: http://hdl.handle.net/2077/34395

Aim: A complex interaction between several factors may influence and explain the variance in outcome after traumatic brain injury (TBI). The overall aim of this thesis was to explore, in individuals with severe TBI, the impact of posttraumatic hypopituitarism (PTHP), a history of unemployment or sick leave, and care pathways on long-term global outcome. Further, to investigate short- and long-term all-cause mortality after severe TBI. Methods: The studies reported in this thesis included a total of 280 participants with severe TBI. In study I and II, a retrospective follow-up was performed of 51 consecutive individuals, age 16–65 years, who were admitted with severe TBI to Sahlgrenska University Hospital, Gothenburg, from 1999 to 2002.The impact of PTHP and of unemployment or sick leave before injury on functioning and health related quality of life (HRQL) was explored. Data from the time of injury were combined into a validated prognostic model to adjust for injury severity. Outcome was measured once, 2 -11 years after trauma, and included hormonal testing, the Short Form-36 Health Survey, the Glasgow Outcome Scale –Extended (GOSE), and a self-report questionnaire specifically designed for these studies. Data on sick leave and unemployment were gathered from the Swedish social insurance agency. Study III was a multi-centre, prospective, observational study of 114 individuals, age 18-65 years, with severe TBI from six neurosurgical centers in Sweden and Iceland, with a follow up one year after the injury. The study assessed the relationship between care pathways (length of stay in intensive care, time between intensive care discharge and rehabilitation admission), and global outcome (GOSE). A validated prognostic model was used to adjust for injury severity. In study IV, a comparison of the cumulative death rates and causes of death between 166 individuals admitted to Sahlgrenska and a community control group, was conducted retrospectively at 10 years after the severe TBI. The data was ascertained from the ...