Scholten A C, Haagsma J A, Andriessen T M J C, Vos P E, Steyerberg E W, van Beeck E F, Polinder S
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Injury. 2015 Apr;46(4):616-24. doi: 10.1016/j.injury.2014.10.064. Epub 2014 Nov 4.
The Glasgow Outcome Scale Extended (GOSE) is the established functional outcome scale to assess disability following traumatic brain injury (TBI), however does not capture the patient's subjective perspective. Health-related quality of life (HRQL) does capture the individual's perception of disability after TBI, and has therefore been recognized as an important outcome in TBI. In contrast to GOSE, HRQL enables comparison of health outcome across various disease states and with healthy individuals. We aimed to assess functional outcome, HRQL, recovery, and predictors of 6 and 12-month outcome in a comprehensive sample of patients with mild, moderate or severe TBI, and to examine the relationship between functional impairment (GOSE) and HRQL.
A prospective cohort study was conducted among a sample of 2066 adult TBI patients who attended the emergency department (ED). GOSE was determined through questionnaires or structured interviews. Questionnaires 6 and 12 months after ED treatment included socio-demographic information and HRQL measured with Short-Form Health Survey (SF-36; reflecting physical, mental and social functioning) and Perceived Quality of Life Scale (PQoL; measuring degree of satisfaction with functioning).
996 TBI survivors with mild, moderate or severe TBI completed the 6-month questionnaire. Functional outcome and HRQL after moderate or severe TBI was significantly lower than after mild TBI. Patients with moderate TBI showed greatest improvement. After one year, the mild TBI group reached outcomes comparable to population norms. TBI of all severities highly affected SF-36 domains physical and social functioning, and physical and emotional role functioning. GOSE scores were highly related to all SF-36 domains and PQoL scores. Female gender, older age, co-morbidity and high ISS were strongest independent predictors of decreased HRQL at 6 and 12 months after TBI.
HRQL and recovery patterns differ for mild, moderate and severe TBI. This study indicates that GOSE, although clinically relevant, fails to capture the subjective perspective of TBI patients, which endorses the use of HRQL as valuable addition to established instruments in assessing disability following TBI. Influence of TBI severity on recovery, together with female gender, older age, co-morbidity and high ISS should be considered in long-term follow-up and intervention programs.
格拉斯哥扩展预后量表（GOSE）是用于评估创伤性脑损伤（TBI）后残疾情况的既定功能预后量表，但未涵盖患者的主观视角。健康相关生活质量（HRQL）确实能够反映TBI后个体对残疾的认知，因此已被视为TBI的一项重要预后指标。与GOSE不同，HRQL能够对不同疾病状态下的健康预后以及与健康个体进行比较。我们旨在评估轻、中、重度TBI患者综合样本在6个月和12个月时的功能预后、HRQL、恢复情况及预后预测因素，并研究功能障碍（GOSE）与HRQL之间的关系。
对2066例就诊于急诊科的成年TBI患者进行了一项前瞻性队列研究。通过问卷调查或结构化访谈确定GOSE。急诊治疗6个月和12个月后的问卷包括社会人口学信息以及使用简短健康调查问卷（SF-36；反映身体、心理和社会功能）和生活质量感知量表（PQoL；测量对功能的满意度）测量的HRQL。
996例轻、中、重度TBI幸存者完成了6个月的问卷调查。中重度TBI后的功能预后和HRQL显著低于轻度TBI后。中度TBI患者改善最大。一年后，轻度TBI组的预后达到了与人群标准相当的水平。所有严重程度的TBI对SF-36的身体和社会功能领域以及身体和情感角色功能均有高度影响。GOSE评分与所有SF-36领域和PQoL评分高度相关。女性、年龄较大、合并症和高损伤严重度评分（ISS）是TBI后6个月和12个月时HRQL降低的最强独立预测因素。
轻、中、重度TBI的HRQL和恢复模式不同。本研究表明，GOSE虽然具有临床相关性，但未能涵盖TBI患者的主观视角，这支持将HRQL作为评估TBI后残疾情况的既定工具的有价值补充。在长期随访和干预计划中应考虑TBI严重程度对恢复的影响，以及女性、年龄较大、合并症和高ISS等因素。
