Citation

Stromberg KA, Agyemang AA, Graham KM, Walker WC, Sima AP, Marwitz JH, Harrison-Felix C, Hoffman JM, Brown AW, Kreutzer JS, Merchant R. J. Head Trauma Rehabil. 2019; 34(3): E64-E74.

Affiliation

Departments of Biostatistics (Ms Stromberg and Dr Sima) and Physical Medicine and Rehabilitation (Drs Agyemang, Graham, Walker, Kreutzer, and Merchant and Ms Marwitz), Virginia Commonwealth University, Richmond; The Traumatic Brain Injury Model Systems National Data and Statistical Center, Craig Hospital, Englewood, Colorado (Dr Harrison-Felix); Department of Rehabilitation Medicine, University of Washington, Seattle (Dr Hoffman); and Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (Dr Brown).

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000438

PMID

30234849

Abstract

OBJECTIVE: To build decision tree prediction models for long-term employment outcomes of individuals after moderate to severe closed traumatic brain injury (TBI) and assess model accuracy in an independent sample. SETTING: TBI Model Systems Centers. PARTICIPANTS: TBI Model Systems National Database participants injured between January 1997 and January 2017 with moderate to severe closed TBI. Sample sizes were 7867 (year 1 postinjury), 6783 (year 2 postinjury), and 4927 (year 5 postinjury).

DESIGN: Cross-sectional analyses using flexible classification tree methodology and validation using an independent subset of TBI Model Systems National Database participants. MAIN MEASURES: Competitive employment at 1, 2, and 5 years postinjury.

RESULTS: In the final employment prediction models, posttraumatic amnesia duration was the most important predictor of employment in each outcome year. Additional variables consistently contributing were age, preinjury education, productivity, and occupational category. Generally, individuals spending fewer days in posttraumatic amnesia, who were competitively employed preinjury, and more highly educated had better outcomes. Predictability in test data sets ranged from a C-statistic of 0.72 (year 5; confidence interval: 0.68-0.76) to 0.77 (year 1; confidence interval: 0.74-0.80).

CONCLUSION: An easy-to-use decision tree tool was created to provide prognostic information on long-term competitive employment outcomes in individuals with moderate to severe closed TBI. Length of posttraumatic amnesia, a clinical marker of injury severity, and preinjury education and employment status were the most important predictors.

Language: en