Long-term disability and survival in traumatic brain injury: Results from the national institute on disability and rehabilitation research model systems

Jordan C. Brooks, David J. Strauss, Robert M. Shavelle, David R. Paculdo, Flora M. Hammond, Cynthia L. Harrison-Felix

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59 Scopus citations

Abstract

Objectives: To document long-term survival in 1-year survivors of traumatic brain injury (TBI); to compare the use of the Disability Rating Scale (DRS) and FIM as factors in the estimation of survival probabilities; and to investigate the effect of time since injury and secular trends in mortality. Design: Cohort study of 1-year survivors of TBI followed up to 20 years postinjury. Statistical methods include standardized mortality ratio, Kaplan-Meier survival curve, proportional hazards regression, and person-year logistic regression. Setting: Postdischarge from rehabilitation units. Participants: Population-based sample of persons (N=7228) who were admitted to a TBI Model Systems facility and survived at least 1 year postinjury. These persons contributed 32,505 person-years, with 537 deaths, over the 1989 to 2011 study period. Interventions: Not applicable. Main Outcome Measure: Survival. Results: Survival was poorer than that of the general population (standardized mortality ratio=2.1; 95% confidence interval, 1.9-2.3). Age, sex, and functional disability were significant risk factors for mortality (P<.001). FIM- and DRS-based proportional hazards survival models had comparable predictive performance (C index:.80 vs.80; Akaike information criterion: 11,005 vs 11,015). Time since injury and current calendar year were not significant predictors of long-term survival (both P>.05). Conclusions: Long-term survival prognosis in TBI depends on age, sex, and disability. FIM and DRS are useful prognostic measures with comparable statistical performance. Age- and disability-specific mortality rates in TBI have not declined over the last 20 years. A survival prognosis calculator is available online (http://www.LifeExpectancy.org/tbims. shtml).

Original languageEnglish (US)
Pages (from-to)2203-2209
Number of pages7
JournalArchives of physical medicine and rehabilitation
Volume94
Issue number11
DOIs
StatePublished - Nov 1 2013

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Keywords

  • Brain injuries
  • Mortality
  • Rehabilitation
  • Survival

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation

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