title: A comprehensive picture of 4-year outcome of severe brain injuries. Results from the PariS-TBI study.
abstract: OBJECTIVE
  Survivors of severe traumatic brain injury have a great variety of impairments and participation restrictions. Detailed descriptions of their long-term outcome are critical. We aimed to assess brain injury outcome for subjects with traumatic brain injury in terms of the International classification of functioning, disability and health.
  
  
  METHODS
  Four-year follow-up of an inception cohort of adults with severe traumatic brain injury by using face-to-face interviews with patients and proxies.
  
  
  RESULTS
  Among 245 survivors at 4 years, 147 were evaluated (80% male, mean age: 32.5±14.2 years at injury); 46 (32%) presented severe disability, 58 (40%) moderate disability, and 40 (28%) good recovery. Most frequent somatic problems were fatigue, headaches, other pain, and balance. One quarter of subjects had motor impairments. Rates of cognitive complaints ranged from 25 to 68%, the most frequent being memory, irritability, slowness and concentration. With the Hospital Anxiety and Depression Scale, 43% had anxiety and 25% depression. Overall, 79% were independent in daily living activities and 40 to 50% needed help for outdoor or organizational activities on the BICRO-39. Most had regular contacts with relatives or close friends but few contacts with colleagues or new acquaintances. Subjects spent little time in productive activities such as working, studying, looking after children or voluntary work. Quality of life on the QOLIBRI scale was associated with disability level (P<0.0001).
  
  
  CONCLUSIONS
  Management of late brain injury needs to focus on cognitive difficulties, particularly social skills, to enhance patient participation in life.
authors.affiliation: Département de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; UFR des sciences de la Santé-Simone Veil, HANDIReSP EA 4047, université de Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France. Electronic address: claire.jourdan@rpc.aphp.fr.
authors.forename: C
authors.initials: C
authors.lastname: Jourdan
authors.affiliation: Laboratoire d'économie et de gestion des organisations de santé (LEDa-LEGOS), université Paris-Dauphine, 75016 Paris, France; Université Pierre-et-Marie-Curie, 75005 Paris, France; Service de médecine physique et de réadaptation, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Bayen
authors.affiliation: Université Pierre-et-Marie-Curie, 75005 Paris, France; Service de médecine physique et de réadaptation, hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, AP-HP, 75013 Paris, France.
authors.forename: P
authors.initials: P
authors.lastname: Pradat-Diehl
authors.affiliation: Unité de recherche clinique (URC), hôpital Ambroise-Paré, AP-HP, 92012 Boulogne, France.
authors.forename: I
authors.initials: I
authors.lastname: Ghout
authors.affiliation: Unité de recherche clinique (URC), hôpital Ambroise-Paré, AP-HP, 92012 Boulogne, France.
authors.forename: E
authors.initials: E
authors.lastname: Darnoux
authors.affiliation: Unité de recherche clinique (URC), hôpital Ambroise-Paré, AP-HP, 92012 Boulogne, France.
authors.forename: S
authors.initials: S
authors.lastname: Azerad
authors.affiliation: Département de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; Université Pierre-et-Marie-Curie, 75005 Paris, France; Antenne UEROS-SAMSAH92-UGECAM IDF, hôpital Raymond-Poincaré, 92380 Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Vallat-Azouvi
authors.affiliation: Centre ressources francilien du traumatisme crânien (CRFTC), 75014 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Charanton
authors.affiliation: Unité de recherche clinique (URC), hôpital Ambroise-Paré, AP-HP, 92012 Boulogne, France; UFR des sciences de la Santé-Simone Veil, UMR-S 1168, université de Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
authors.forename: P
authors.initials: P
authors.lastname: Aegerter
authors.affiliation: Département de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France.
authors.forename: A
authors.initials: A
authors.lastname: Ruet
authors.affiliation: Département de médecine physique et de réadaptation, hôpital Raymond-Poincaré, AP-HP, 104, boulevard Raymond-Poincaré, 92380 Garches, France; UFR des sciences de la Santé-Simone Veil, HANDIReSP EA 4047, université de Versailles Saint-Quentin, 2, avenue de la Source-de-la-Bièvre, 78180 Montigny-Le-Bretonneux, France.
authors.forename: P
authors.initials: P
authors.lastname: Azouvi
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology; D001930:Brain Injuries / Q000150:complications* / Q000523:psychology*; D003072:Cognition Disorders / Q000209:etiology; D003863:Depression / Q000209:etiology; D006233:Persons with Disabilities / Q000523:psychology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology; D004856:Postural Balance; D011788:Quality of Life; D058992:Social Participation; D013997:Time Factors; D055815:Young Adult
keywords: Brain injuries; Craniocerebral trauma; International classification of functioning, disability and health; Quality of life