Research Reports - Neurologic functional and quality of life outcomes after TBI: Clinic attendees versus non-attendees

J Neurotrauma. 2015 Apr 24

Patel MB(1), Wilson LD, Bregman JA, Leath TC, Humble SS, Davidson MA, de Riesthal
MR, Guillamondegui OD

This investigation describes the relationship between TBI patient demographics,
quality of life outcome, and functional status outcome among clinic attendees and
non-attendees. Of adult TBI survivors with intracranial hemorrhage, 63 attended
our TBI clinic and 167 did not attend. All were telephone surveyed using the
Extended-Glasgow Outcome Scale (GOSE), the Quality of Life after Brain Injury
(QOLIBRI) scale, and a post-discharge therapy questionnaire. To determine risk
factors for GOSE and QOLIBRI outcomes, we created multivariable regression models
employing covariates of age, injury characteristics, clinic attendance, insurance
status, post-discharge rehabilitation, and time from injury. Compared with those
with severe TBI, higher GOSE scores were identified in individuals with both mild
(odds ratio [OR]=2.0; 95% confidence interval [CI]: 1.1-3.6) and moderate
(OR=4.7; 95% CI: 1.6-14.1) TBIs. In addition, survivors with private insurance
had higher GOSE scores, compared with those with public insurance (OR=2.0; 95%
CI: 1.1-3.6), workers' compensation (OR=8.4; 95% CI: 2.6-26.9), and no insurance
(OR=3.1; 95% CI: 1.6-6.2). Compared with those with severe TBI, QOLIBRI scores
were 11.7 points (95% CI: 3.7-19.7) higher in survivors with mild TBI and 17.3
points (95% CI: 3.2-31.5) higher in survivors with moderate TBI. In addition,
survivors who received post-discharge rehabilitation had higher QOLIBRI scores by
11.4 points (95% CI: 3.7-19.1) than those who did not. Survivors with private
insurance had QOLIBRI scores that were 25.5 points higher (95% CI: 11.3-39.7)
than those with workers' compensation and 16.8 points higher (95% CI: 7.4-26.2)
than those without insurance. Because neurologic injury severity, insurance
status, and receipt of rehabilitation or therapy are independent risk factors for
functional and quality of life outcomes, future directions will include improving
earlier access to post-TBI rehabilitation, social work services, affordable
insurance, and community resources.

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