Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended

Rabea Iris Pantelatos; Jonas Stenberg; Turid Follestad; Oddrun Sandrød; Cathrine Elisabeth Einarsen; Anne Vik; Toril Skandsen

doi:10.1089/neur.2023.0109

Improvement in Functional Outcome from 6 to 12 Months After Moderate and Severe Traumatic Brain Injury Is Frequent, But May Not Be Detected With the Glasgow Outcome Scale Extended

Neurotrauma Rep. 2024 Feb 29;5(1):139-149. doi: 10.1089/neur.2023.0109. eCollection 2024.

Authors

Rabea Iris Pantelatos¹, Jonas Stenberg^{1

2

3}, Turid Follestad^{4

5}, Oddrun Sandrød⁶, Cathrine Elisabeth Einarsen^{1

7}, Anne Vik^{1

8}, Toril Skandsen^{1

7}

Affiliations

¹ Department of Neuromedicine, Movement Science, and Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
² Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden.
³ Department of Radiology and Nuclear Medicine, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁴ Clinical Research Unit Central Norway, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁵ Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
⁶ Clinic of Anaesthesia and Intensive Care, Department of Intensive Care Medicine, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁷ Clinic of Rehabilitation, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Neuroclinic, Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.

Abstract

The aims of this study were (1) to report outcome and change in outcome in patients with moderate and severe traumatic brain injury (mo/sTBI) between 6 and 12 months post-injury as measured by the Glasgow Outcome Scale Extended (GOSE), (2) to explore if demographic/injury-related variables can predict improvement in GOSE score, and (3) to investigate rate of improvement in Disability Rating Scale (DRS) score, in patients with a stable GOSE. All surviving patients ≥16 years of age who were admitted with mo/sTBI (Glasgow Coma Scale [GCS] score ≤13) to the regional trauma center in Central Norway between 2004 and 2019 were prospectively included (n = 439 out of 503 eligible). GOSE and DRS were used to assess outcome. Twelve-months post-injury, 13% with moTBI had severe disability (GOSE 2-4) versus 27% in sTBI, 26% had moderate disability (GOSE 5-6) versus 41% in sTBI and 62% had good recovery (GOSE 7-8) versus 31% in sTBI. From 6 to 12 months post-injury, 27% with moTBI and 32% with sTBI had an improvement, whereas 6% with moTBI and 6% with sTBI had a deterioration in GOSE score. Younger age and higher GCS score were associated with improved GOSE score. Improvement was least frequent for patients with a GOSE score of 3 at 6 months. In patients with a stable GOSE score of 3, an improvement in DRS score was observed in 22 (46%) patients. In conclusion, two thirds and one third of patients with mo/sTBI, respectively, had a good recovery. Importantly, change, mostly improvement, in GOSE score between 6 and 12 months was frequent and argues against the use of 6 months outcome as a time end-point in research. The GOSE does, however, not seem to be sensitive to actual change in function in the lower categories and a combination of outcome measures may be needed to describe the consequences after TBI.

Keywords: Disability Rating Scale; Glasgow Coma Scale; Glasgow Outcome Scale; adult; clinical deterioration; cohort studies; craniocerebral trauma; longitudinal studies; patient outcome assessment; prospective studies; recovery of function.