Citation

Beck B, Gantner D, Cameron P, Braaf SC, Saxena M, Cooper DJ, Gabbe B. J. Neurotrauma 2018; 35(8): 1021-1029.

Affiliation

Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Australia ; belinda.gabbe@monash.edu.

Copyright

(Copyright © 2018, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2017.5287

PMID

29256832

Abstract

Severe traumatic brain injury (TBI) is associated with poor outcomes, however, little is known about whether these outcomes are improving over time. This study examined temporal trends in functional outcomes of severe TBI at 6-months post-injury. We conducted a retrospective cohort study (1 January 2006 to 31 December 2015) of hospitalised adult (≥16 years) severe TBI patients using data from the population-based Victorian State Trauma Registry. The primary outcome was the Glasgow Outcome Scale-Extended (GOS-E) at 6 months post-injury, dichotomised as upper severe disability or worse (GOS-E ≤ 4; termed 'unfavourable outcome') and lower moderate disability or better (GOS-E ≥ 5; termed 'favourable outcome'). Multivariable logistic regression was used to investigate temporal trends in functional outcomes at 6 months post-injury. Of the 1,966 severe TBI patients who were followed-up at 6-months post-injury (median age, 42 years (IQR: 25-68); male, 73%), a majority of patients had an unfavourable outcome (GOS-E ≤ 4; n=1372, 70%). After adjusting for confounders, there was no change in functional outcomes over time (adjusted odds ratio (AOR) =1.02, 95% CI:0.98,1.06; P=0.35). Similarly, there was no change in the adjusted odds of death (GOS-E=1) at 6 months post-injury (AOR=1.04, 95% CI:1.00,1.08; P=0.08). Using a population-wide, high quality, comprehensive registry, we demonstrated no change in mortality or functional outcomes following severe TBI between 2006 and 2015 in a mature trauma system. There is a clear need to identify targeted improvements in the management of these patients with the aim of reducing in-hospital mortality and improving long-term outcomes.

Language: en

Keywords

HEAD TRAUMA; RECOVERY; TRAUMATIC BRAIN INJURY