title: Neurologic Functional and Quality of Life Outcomes after TBI: Clinic Attendees versus Non-Attendees.
abstract: 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.
authors: 1 Veterans Affairs (VA) Tennessee Valley Healthcare System , Nashville VA, Nashville, Tennessee.|2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Mayur B
authors: MB
authors: Patel
authors: 3 Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Laura D
authors: LD
authors: Wilson
authors: 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Jana A
authors: JA
authors: Bregman
authors: 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Taylor C
authors: TC
authors: Leath
authors: 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Stephen S
authors: SS
authors: Humble
authors: 4 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Mario A
authors: MA
authors: Davidson
authors: 3 Department of Hearing and Speech Sciences, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Michael R
authors: MR
authors: de Riesthal
authors: 2 Department of Surgery and Neurosurgery, Vanderbilt University School of Medicine , Nashville, Tennessee.
authors: Oscar D
authors: OD
authors: Guillamondegui
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007348:Insurance, Health; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014942:Workers' Compensation
keywords: TBI clinic; neurologic function outcome; quality of life outcome; rehabilitation; traumatic brain injury