Global outcome, productivity and epilepsy 3--8 years after severe head injury. The impact of injury severity.
OBJECTIVE
To assess long-term outcome in survivors after severe head injury and relate outcome to injury severity.


METHODS
Follow-up 3-8 years post injury in a retrospectively collected sample.


METHODS
A neurosurgical department in a regional trauma centre.


METHODS
Of 146 individuals admitted, 135 were actively treated. Twenty-four per cent of these died within six months. Ninety-three of the 94 (aged 1-88 years) who survived more than three years were included in the follow-up. They were separated into groups based on their level of consciousness at four weeks post injury: oriented (n = 39), confused (n = 22) or in a minimally conscious/vegetative state (MCS/VS) (n = 26) and not possible to assess (n = 6).


METHODS
Glasgow Outcome Scale Extended (GOSE), participation in work/education (productivity) and posttraumatic epilepsy.


RESULTS
GOSE scores were: vegetative state: 3%, severe disability: 28% (22% lower level, 6% upper level), moderate disability: 39% (22% lower level, 17% upper level) and good recovery: 27% (10% lower level, 17% upper level). Productivity was 34% (aged 7-64 years). The three severity groups had different GOSE scores (P<0.001) and different proportion of productive individuals (P<0.001). Twenty-three per cent experienced posttraumatic epilepsy and this was significantly associated with the highest injury severity (P<0.001) and intracranial surgery (P = 0.01).


CONCLUSIONS
Being independent in daily life but unable to work was the typical long-term outcome. Stratifying the patients based on consciousness at four weeks we found different outcomes. Among oriented patients, almost all regained independency, whereas in the most severe group, poor outcomes and posttraumatic epilepsy was common.
Skandsen
Toril
T
Department of Neuroscience, Norwegian University of Science and Technology, Department of Physical Medicine and Rehabilitation, St Olavs Hospital, Trondheim, Norway. toril.skandsen@ntnu.no
Ivar Lund
Tom
T
Fredriksli
Oddrun
O
Vik
Anne
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004651:Employment; D004827:Epilepsy / Q000209:etiology* / Q000534:rehabilitation; D005260:Female; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome