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Disability in young people and adults one year after head injury: prospective cohort study.

ABSTRACT: OBJECTIVE:To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. DESIGN:Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. SETTING:Five acute hospitals in Glasgow. SUBJECTS:2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. MAIN OUTCOME MEASURES:Glasgow outcome scale and problem orientated questionnaire. RESULTS:Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. CONCLUSION:The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.

SUBMITTER: Thornhill S

PROVIDER: S-EPMC27407 | biostudies-literature | 2000 Jun

REPOSITORIES: biostudies-literature

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Disability in young people and adults one year after head injury: prospective cohort study.

Thornhill S S Teasdale G M GM Murray G D GD McEwen J J Roy C W CW Penny K I KI

BMJ (Clinical research ed.) 20000601 7250

<h4>Objective</h4>To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community.<h4>Design</h4>Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score.<h4>Setting</h4>Five acute hospitals in Glasgow.<h4>Subjects</h4>2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated.<h4>Main outcome ...[more]

PMID: 10856063

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Project description:ObjectiveProlonged post-concussive symptoms (PCS) affect a significant minority of patients withmild traumatic brain injury (mTBI). The aetiology is multifactorial depending on preinjury as well as peri-injury and postinjury factors. In this study, we examine outcome from an emotional reserve perspective.DesignProspective cohort study.SettingPatients were recruited from three emergency departments in major university hospitals in Stockholm, Sweden. Follow-up data were collected in an outpatient setting at one of the recruiting hospitals.Participants122 patients with a history of blunt head trauma (aged 15-65 years; admitted for mTBI within 24 hours after trauma (Glasgow Coma Scale score of 14-15, loss of consciousness <30 min and/or post-traumatic amnesia <24 hours). Exclusion criteria were other significant physical injury and other major neurological disorder, including previous significant head injury.ProcedureRecruitment in three emergency departments. Initial assessments were made within 1 week after the injury. Patients were mailed the follow-up questionnaires 1 year postinjury.Outcome measuresA psychiatric assessment was performed at 1 week post injury. The participants also completed a personality inventory, measures of psychological resilience, depression, anxiety and post-traumatic symptoms. One-year outcome was measured by the Rivermead Post Concussion Symptoms and the Rivermead Head Injury Follow-Up questionnaires.ResultsThe psychiatric assessment revealed more symptoms of anxiety, depression and post-traumatic symptoms in the acute stage for patients who later developed PCS.After 1 year, 94 participants were still in the programme (male/female 57/37) and 12% matched the extended criteria for PCS (≥3 symptoms and ≥2 disabilities). PCS patients reported more preinjury and concurrent psychiatric problems, lower level of functioning before the injury and experienced more stress. They showed higher somatic trait anxiety, embitterment, mistrust and lower level of psychological resilience than recovered participants.ConclusionIntrapersonal emotional reserve shape the emergence and persistence of PCS after mTBI.

Project description:ObjectiveTo evaluate the role of intervening hospital admissions on trajectories of disability in the last year of life.DesignProspective cohort study.SettingGreater New Haven, Connecticut, United States, from March 1998 to June 2013.Participants552 decedents from a cohort of 754 community living people, aged 70 years or older, who were initially non-disabled in four essential activities of daily living: bathing, dressing, walking, and transferring.Main outcome measureOccurrence of admissions to hospital and severity of disability (range 0-4), ascertained during monthly interviews for more than 15 years.ResultsIn the last year of life, six distinct trajectories of disability were identified, from least disabled to most disabled: 95 participants (17.2%) had no disability, 61 (11.1%) had catastrophic disability, 53 (9.6%) had accelerated disability, 61 (11.1%) had progressively mild disability, 127 (23.0%) had progressively severe disability, and 155 (28.1%) had persistently severe disability. 392 (71.0%) participants had at least one hospital admission and 248 (44.9%) had multiple hospital admissions. For each trajectory the course of disability closely tracked the monthly prevalence of hospital admission. In a set of multivariable models that included several potential confounders, hospital admission in a given month had a strong independent effect on the severity of disability, in both relative and absolute terms. The largest absolute effect was observed for catastrophic disability, with a mean increase in disability score of 1.9 (95% confidence interval 1.5 to 2.4) in the setting of a hospital admission, corresponding to a rate ratio (or relative effect) of 2.0 (95% confidence interval 1.5 to 2.7).ConclusionsIn the last year of life, acute hospital admissions play an important role in the disabling process. Knowledge about the course of disability before these intervening events may facilitate clinical decision making at the end of life. For older patients admitted to hospital with progressive or persistent levels of severe disability, representing more than half of the decedents, clinicians might consider a palliative care approach to facilitate discussions about advance care planning and to better deal with personal care needs.

Dataset Information

Disability in young people and adults one year after head injury: prospective cohort study.

Publications

Disability in young people and adults one year after head injury: prospective cohort study.

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