Predictors of quality of life after moderate to severe traumatic brain injury

To verify correlations between age, injury severity, length of stay (LOS), cognition, functional capacity and quality of life (QOL) six months after hospital discharge (HD) of victims of traumatic brain injury (TBI).

Method

50 patients consecutively treated in a Brazilian emergency hospital were assessed at admission, HD and six months after HD. The assessment protocol consisted in Abbreviated Injury Scale, Injury Severity Score, Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), Mini Mental Test, Barthel Index and World Health Organization QOL - Brief.

Results

Strong negative correlation was observed between LOS and GCS and LOS and RTS. An almost maximal correlation was found between RTS and GCS and functional capacity and GCS at HD. Age and LOS were considered independent predictors of QOL.

Conclusion

Age and LOS are independent predictors of QOL after moderate to severe TBI.

brain injuries; epidemiology; quality of life

Variables	Number	%
Gender
Male	44	88
Female	6	12
Race/ethnicity
White	44	88
Black	3	6
Mullato	3	6
Age (years)
18 - 25	14	28
26 - 35	11	22
36 - 45	10	20
45 - 55	4	8
56 - 65	6	12
66 or older	5	10
Education
Illiterate	3	6
Incompleted primary	8	16
Completed primary	8	16
Incompleted gymnasium	11	22
Completed gymnasium	2	4
Incompleted high school	7	14
Completed high school	10	20
Incompleted college	1	2

Variables	number	%
Causes of TBI
Automobile	16	32
Fall	12	24
Bike	6	12
Running over	6	12
Motorcycling	3	6
Physical aggression	6	12
Firearm	1	2
Causes of TBI according to age group
15 – 25 years old
Traffic accidents of motor vehicles	10	20
Aggressions	1	2
Accidental falls	2	4
Homicide and injuries caused intentionally by others	1	2
26 – 35 years old
Traffic accidents of motor vehicles	9	18
Aggressions	2	4
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
36 – 45 years old
Traffic accidents of motor vehicles	5	10
Aggressions	2	4
Accidental falls	3	6
Homicide and injuries caused intentionally by others	0	0
46 – 55 years old
Traffic accidents of motor vehicles	3	6
Aggressions	1	2
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
56 – 65 years old
Traffic accidents of motor vehicles	2	4
Aggressions	3	6
Accidental falls	0	0
Homicide and injuries caused intentionally by others	0	0
66 – 85 years old
Traffic accidents of motor vehicles	2	4
Aggressions	0	0
Accidental falls	4	8
Homicide and injuries caused intentionally by others	0	0
Other lesions
Head	50	100
Face	15	30
Neck	1	2
Chest	11	22
Column	4	8
Abdomen	7	14
Upper limbs	14	28
Lower limbs	10	20
Pelvis	1	2

Groups (age range)	Number of subjects	ISS admission	RTS admission	Glasgow admission	BI		MMSE

					discharge	6 months	discharge	6 months

		mean±SD	mean±SD	median	mean±SD	mean±SD	mean±SD	mean±SD

		(min-max)	(min-max)	(min-max)	median (min-max)	median (min-max)	(min-max)	(min-max)
Group A (18–85 years)	50	17.6 ± 8.6	6.3 ± 1.3	8	29.8 ± 30.1	83 ± 30.2	11.4 ± 8.5	23.2 ± 7.2
Group A (18–85 years)	50	(4–47)	(7.8–4.0)	(3–15)	25 (0–100)	100 (0–100)	(0–27)	(0–30)
Group B (18–25 years)	14	19.7 ± 5.6	6.3 ± 1.3	8	29.2 ± 23.4	95.4 ± 10.5	15.4 ± 9.3	27.25 ± 3.3
Group B (18–25 years)	14	(10–30)	(4.1–7.8)	(3–15)	30 (0–65)	100 (65–100)	(0–27)	(21–30)
Group C (26–35 years)	8	16.2 ± 9.3	6 ± 1.5	8	19.4 ± 30.8	64.3 ± 41.6	7.6 ± 8.3	18.7 ± 9.7
Group C (26–35 years)	8	(10–34)	(4–7.8)	(3–14)	0 (0–85)	85 (0–100)	(0–17)	(0–29)
Group D (36–45 years)	12	21 ± 12	5.9 ± 1.3	7.5	33.75 ± 33.5	88.9 ± 24,6	9.9 ± 6.7	22.9 ± 3.9
Group D (36–45 years)	12	(5–47)	(4–7.8)	(3–14)	27.5 (0–100)	100 (25–100)	(0–17)	(17–28)
Group E (45–55 years)	5	17 ± 1.73	5.9 ± 1.2	6	38 ± 36.8	100 ± 0	13.2 ± 9.3	27 ± 2.9
Group E (45–55 years)	5	(14–18)	(4.5–7.8)	(5–15)	20 (0–80)	100 (100–100)	(0–24)	(23–30)
Group F (56–65 years)	6	13 ± 6.6	7.2 ± 1	13.5	40.8 ± 29.1	78 ± 30.9	13.3 ± 7.4	23 ± 5
Group F (56–65 years)	6	(5–22)	(5.97–7.8)	(7–15)	35 (10–85)	100 (35–100)	(0–20)	(16–28)
Group G (66–85 years)	5	11.6 ± 8.2	7.2 ± 0.6	12	17 ± 38	45 ± 50.7	5.2 ± 8.3	14.3 ± 15
Group G (66–85 years)	5	(4–24)	(6.6–7.8)	(9–15)	0 (0–85)	35 (0–100)	(0–19)	(0–30)

Dependent variable	Independent Variable	Spearman Correlation	Linear Regression

		p-value (r)	95%CI	Alpha	Beta	p-value	R²2. Carvalho AO, Bez Júnior A. Caracterização das vítimas de trauma assistidas por um serviço de atendimento pré-hospitalar. Einstein. 2004;2(3):199-205.
Psychological domain	Age	0.04 (0.33)	0.14 to -0.01	15.61	0.33	0.04	0.11
Psychological domain	LOS	0.02 (0.37)	-0.91 to -0.01	17.41	0.80	0.02	0.14
Environmental domain	Age	0.02 (0.36)	0.12 to -0.01	16.30	0.06	0.02	0.15
Environmental domain	LOS	p = 0.17 (-0.23)	NA	NA	NA	NA	NA
Physical domain	Age	p = 0.22 (-0.20)	NA	NA	NA	NA	NA
Physical domain	LOS	0.01 (0.42)	-0.09 to -0.01	15.81	0.05	0.04	0.11

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[1] Correspondence: Taiza E. G. Santos-Pontelli; Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo; Av. dos Bandeirantes, 3900; 14049-900 Ribeirão Preto SP, Brasil. E-mail: taiza@fmrp.usp.br