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Global Outcome Trajectories After TBI Among Survivors and Nonsurvivors: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

Dams-O'Connor, Kristen PhD; Pretz, Christopher PhD; Billah, Tausif BS; Hammond, Flora M. MD, FACRM; Harrison-Felix, Cynthia PhD, FACRM

Journal of Head Trauma Rehabilitation: July/August 2015 - Volume 30 - Issue 4 - p E1–E10
doi: 10.1097/HTR.0000000000000073
TBI Model Systems 2015

Objective: To compare long-term functional outcome trajectories of individuals with traumatic brain injury (TBI) who survive with those who expire more than 5 years postinjury, using individual growth curve analysis.

Design: Secondary analysis of data from a multicenter longitudinal cohort study.

Setting: Acute inpatient rehabilitation facilities that are current or former TBI Model Systems.

Participants: Individuals 16 years and older with a primary diagnosis of TBI.

Main Outcome Measures: Glasgow Outcome Scale–Extended; Disability Rating Scale.

Results: Individuals in the TBI Model Systems who expire several years after injury demonstrate worse functional status at baseline and a steeper rate of decline over time as measured by both the Glasgow Outcome Scale–Extended and the Disability Rating Scale. There was significant variability in each growth parameter (P < .05) for both instruments. A reduced model was built for each outcome, including all covariates that related significantly to the growth parameters. An interactive tool was created for each outcome to generate individual-level trajectories based on various combinations of covariate values.

Conclusion: Individuals with TBI who die several years after injury demonstrate functional trajectories that differ markedly from those of survivors. Opportunities should be sought for health management interventions to improve health and longevity after TBI.

Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor and Mr Billah); Research Department, Craig Hospital, Englewood, Colorado (Drs Pretz and Harrison-Felix); and Indiana University School of Medicine, Indianapolis (Dr Hammond).

Corresponding Author: Kristen Dams-O'Connor, PhD, Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1240B, New York, NY 10029 (kristen.dams-o'

This work was funded by the Traumatic Brain Injury Model Systems (TBIMS) National Data and Statistical Center (National Institute on Disability and Rehabilitation Research [NIDRR] grant no. H133A110006), the New York TBIMS (NIDRR grant no. H133A070033), and Indiana University TBIMS (NIDRR grant no. H133A120035).

We certify that no party having a direct interest in the results of the research supporting this article has or will confer a benefit on us or on any organization with which we are associated and we certify that all financial and material support for this research are clearly identified in the article.

The authors declare no conflicts of interest.

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