Research Reports - Long-term survival after traumatic brain injury

Arch Phys Med Rehabil. 2015 Jun;96(6):994-999

Brooks JC(1), Shavelle RM(2), Strauss DJ(2), Hammond FM(3), Harrison-Felix CL(4)

OBJECTIVES: To develop prognostic models for long-term survival in adults with
traumatic brain injury (TBI) and to assess their external validity in 2
independent populations.
DESIGN: Survival analysis.
SETTING: Post-discharge from rehabilitation units and long-term follow-up at
regional centers.
PARTICIPANTS: Two cohorts of long-term survivors of TBI (N=12,481): the Traumatic
Brain Injury Model Systems (TBIMS) cohort comprised 7365 persons who were
admitted to a TBIMS facility and were assessed at ≥1 years postinjury, and the
California Department of Developmental Services (CDDS) cohort comprised 5116
persons who sustained a TBI and received long-term services from the CDDS.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Survival/mortality.
RESULTS: Older age, male sex, and severity of disability in walking and feeding
were significant predictors of increased long-term mortality rates (all P<.05,
both databases). The CDDS model predicted 623 deaths for persons in the TBIMS
cohort, with an observed-to-expected ratio of .94 (95% confidence interval [CI],
0.87-1.02). The TBIMS model predicted a total of 525 deaths for persons in the
CDDS cohort, with an observed-to-expected ratio of 1.08 (95% CI, 0.99-1.17).
Regression calibration statistics were satisfactory, and both models ranked
survival times well from shortest to longest (TBIMS: C index, .78; 95% CI,
.76-.80; CDDS: C index, .80; 95% CI, .78-.82).
CONCLUSIONS: Long-term survival prognosis in TBI is related to age, sex, and
severity of disability. When compared on the basis of these factors, the survival
estimates derived from the TBIMS and CDDS cohorts are found to be similar. The
close agreement between model predictions and actual mortality rates confirm the
external validity of the prognostic models presented herein.

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