Long-Term Disability and Survival in Traumatic Brain Injury: Results From the National Institute on Disability and Rehabilitation Research Model Systems

• Published in: Archives of physical medicine and rehabilitation Vol. 94; no. 11; pp. 2203 - 2209
• Main Authors: Brooks, Jordan C., PhD, MPH, Strauss, David J., PhD, Shavelle, Robert M., PhD, Paculdo, David R., MPH, Hammond, Flora M., MD, Harrison-Felix, Cynthia L., PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2013
• Subjects: Adult; Brain injuries; Brain Injuries - mortality; Brain Injuries - rehabilitation; Disabled Persons - rehabilitation; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Mortality; Physical Medicine and Rehabilitation; Prognosis; Rehabilitation; Risk Factors; Survival; Young Adult; standardized mortality ratio; SSDI; DRS; Mortality; CI; traumatic brain injury; Disability Rating Scale; Akaike information criterion; Survival; Brain injuries; SMR; confidence interval; TBI; Rehabilitation; AIC; Social Security Death Index
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2013.07.005

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 ).