Disability in young people and adults after head injury: 12-14 year follow-up of a prospective cohort.
BACKGROUND
There is a need to establish how long term outcome evolves after head injury (HI) and factors related to this, to inform opportunities for intervention.


OBJECTIVE
To determine late outcome in adults 12-14 years after hospital admission for HI and to examine relationships between injury, early and late factors, and disability.


METHODS
A prospective cohort with HI, whose outcome was reported previously at 1 and 5-7 years after injury, were followed up after 12-14 years. Participants were assessed using structured and validated measures of disability (Glasgow Outcome Scale-Extended), psychological well being, alcohol use and health status.


RESULTS
Of 219 survivors followed-up at 5-7 years, 34 (15.5%) had died by 12-14 years. Disability remained common in survivors at 12-14 years (51%), as found at 1 and 5-7 years (53%). For those disabled at 1 year, outcome was poor, with 80% dead or disabled at 12-14 years. Older age at injury, a premorbid history of brain illness or physical disability and post-injury low self-esteem and stress were associated with disability at 12-14 years. Disability changed between 5-7 and 12-14 years in 55% of survivors, improving in 23%. Late changes in disability between 5-7 and 12-14 years were associated with self-perceptions of locus of control as being 'powerful others' at 5-7 years.


CONCLUSIONS
Disability is common 12-14 years after hospital admission with a HI. For some there is a dynamic process of change in disability over time that is associated with self-perceptions of control that could be a target for intervention based research.
Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK. thomas.mcmillan@glasgow.ac.uk
Thomas M
TM
McMillan
Graham M
GM
Teasdale
Elaine
E
Stewart
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006259:Craniocerebral Trauma / Q000401:mortality* / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors