Research Reports - Negative impact of litigation procedures on patient outcomes four years after severe traumatic brain injury

Disabil Rehabil. 2017 May 16:1-8. doi: 10.1080/09638288.2017.1325522. [Epub ahead
of print]

Bayen E(1), Jourdan C(2), Ghout I(3), Pradat-Diehl P(4), Darnoux E(3), Nelson
G(3), Vallat-Azouvi C(5), Charenton J(6), Aegerter P(3), Ruet A(7), Azouvi P(5).

PURPOSE: To analyze the effect of litigation procedures on long-term outcomes in
severe traumatic brain injury.
MATERIALS AND METHODS: Prospective observational follow-up of an inception cohort
including 504 adults with severe traumatic brain injury recruited in 2005-2007 in
the Parisian area, France, with initial, one- and four-year outcomes measures.
RESULTS: Four years after the traumatic brain injury, 147 patients, out of 257
who survived the acute phase, were assessed. Among these patients, 53 patients
declared being litigants and 78 nonlitigants (litigation status was unknown in 16
cases). Sociodemographic characteristics, type of injury and initial severity did
not differ significantly between litigants and nonlitigants, except for Injury
Severity Score (worse in litigants) and the proportion of road traffic accidents
(higher in litigants). One- and four-year outcomes were significantly worse in
litigants for autonomy, participation, psychiatric and cognitive function but not
quality of life (measured with the Glasgow Outcome Scale-Extended, the working
activity status, the Brain Injury Community Rehabilitation Outcome, the Hospital
Anxiety and Depression scale, the Neurobehavioral Rating Scale-revised and the
Quality of Life after Brain Injury, respectively). Multivariate analyses
highlighted litigation procedure as an independent significant predictor of lower
autonomy, participation and psychiatric function and tended to predict lower
cognitive function, but not lower quality of life, after adjustment for pretrauma
characteristics, Injury Severity Score, road traffic accidents and work-related
accident status.
CONCLUSIONS: Patients with severe traumatic brain injury have a worse prognosis
when involved in a litigation procedure and require special attention in clinical
practice. Implications for rehabilitation The influence of litigation procedure
on health and social outcomes in severe traumatic brain injury is a major issue
that entail numerous levels of complexities. A wide range of interactions and
factors related to the prolonged process of litigation against a third party may
influence recovery. Results from the PariS-Traumatic Brain Injury study suggest
that patients with a severe Traumatic Brain Injury who are involved in a
litigation procedure within French jurisdiction compensation scheme have a worse
prognosis than patients who do not. Health professionals should be aware of the
potential adverse effects of litigation procedures on recovery, and provide
appropriate interventions and information to patients and families in such cases. 

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