8-year outcome after severe traumatic brain injury: Results from the Paris-TBI Study

Introduction/Background Traumatic Brain Injury (TBI) is a leading cause of acquired persistent disabilities. Sequalae increase with TBI severity. As young adults are particularly exposed, TBI represent an important health and economic burden. However, long-term outcome is poorly described in scientific literature. Material and method Prospective observational study of an inception cohort of adult patients with severe traumatic brain injury in the Parisian area (Paris-TBI). Outcome description assessed with face-to-face interview 8 years after TBI. Results Five hundred and four patients were included between 2005 and 2007, 257 were discharged alive from acute care. At 8-year follow-up, 261 of initial 504 were deceased, 128 patients were lost to follow-up, 22 refused to participate, 86 were finally evaluated. Mean age was 41.9 (SD 13.6), 79% were male, median initial Glasgow Coma Scale Score (GOS) was 6. Age, sex, initial severity did not differ between evaluated patients and lost to follow-up who were more frequently students or unemployed. Detailed information on impairments, functional status, activities were obtained. 5% were institutionalized. 11% suffered seizure since TBI. According to GOS-Extended scale score, 30% remained severely disabled, 41% moderately disabled, 29% had a good recovery. The most frequent somatic disorders concern balance (47.5%), motricity (31%), headaches (36%) and were less frequent than cognitive complaints (Memory 71%, Slowness 68%, Concentration 67%). On Hospital Anxiety and Depression scale, 16% had a score > 10 for anxiety and 18% for depression. At 8 years, 12% worked temporarily after TBI 4, 45% had a job. Of those 37%, declared a salary loss since TBI. Among those who did not returned to work, 89% declared that was because of TBI consequences. Conclusion These results from an inception cohort highlight that adult patients frequently suffer cognitive and somatic disorders after severe TBI. Long after the TBI, these impairments still interfere with social integration and participation.