title: Injury severity measures for predicting return-to-work after a traumatic brain injury.
abstract: This study compared the ability of five injury severity measures, namely the Abbreviated Injury Scale to the Head (AIS-H), Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), Extended Glasgow Outcome Scale (GOSE), and Injury Severity Score (ISS), to predict return-to-work after a traumatic brain injury (TBI). Furthermore, factors potentially associated with return-to-work were investigated. In total, 207 individuals aged ≤65 years newly diagnosed with a TBI and employed at the time of injury were recruited and followed-up for 1year by telephone every 3 months. A bivariate proportional hazards model analysis revealed that all five injury severity measures were significantly associated with return-to-work after a TBI. The AIS-H and non-head ISS explained 23.8% of the variation in the duration of returning to work from discharge after hospitalization for a TBI; similarly, the GCS, GOS, GOSE, and ISS respectively accounted for 4.7%, 21.4%, 12.9%, and 48.4% of the variation. A multivariable analysis revealed that individuals with higher injury severity as measured by the ISS (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.92-0.97), a lack of autonomy in transportation (HR, 2.55; 95% CI, 1.23-5.32), cognitive impairment (HR, 0.47; 95% CI, 0.28-0.79), and depression (HR, 0.97; 95% CI, 0.95-0.99) were significantly less likely to be employed after a TBI. In conclusion, of the five injury severity measures, the ISS may be the most capable measure of predicting return-to-work after a TBI. In addition to injury severity, autonomy in transportation, cognitive function, and the depressive status may also influence the employment status during the first year after a TBI.
authors.affiliation: Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Ding-Kuo
authors.initials: DK
authors.lastname: Chien
authors.affiliation: Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
authors.forename: Hei-Fen
authors.initials: HF
authors.lastname: Hwang
authors.affiliation: Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Master's Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan. Electronic address: mrlin@tmu.edu.tw.
authors.forename: Mau-Roung
authors.initials: MR
authors.lastname: Lin
mesh_terms: D015998:Abbreviated Injury Scale; D000368:Aged; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D062707:Return to Work / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014938:Work Capacity Evaluation
keywords: AIS; Employment; ISS; Injury severity; Return-to-work; Traumatic brain injury