Skip to main content

One-year outcome following brain injury: a comparison of younger versus elderly major trauma patients

Abstract

Introduction

The increasing number of older trauma patients has provoked a debate on the need for subsequent rehabilitative therapy for the elderly. Our findings revealed a lack of detailed data on this topic so we became interested in the effective differences in the longer-term outcomes for older and younger major trauma patients with TBI. As validation studies on the recently published specific Quality of Life after Brain Injury (QOLIBRI) have only involved patients under the age of 68 years, we focused on testing this score in comparison to other outcome measures.

Materials and methods

Prospective cohort study of the differences in 1-year functional or health-related quality of life (HRQoL) outcomes, such as the Glasgow Outcome Score (GOS), the Quality of Life after Brain Injury (QOLIBRI) score or the medical outcomes study Short Form-36 (SF-36) between younger (16–64 years) and elderly (> 65 years) adults following major trauma (New Injury Severity Score, NISS ≥ 8) with TBI (Abbreviated Injury Scale, AIS head > 0).

Results

Out of 326 TBI patients with a mean NISS of 20.6 ± 9.4 34% (n = 110 (33.7%)) were aged 65 or older versus n = 216 (66.3%) who were younger. Comparison of 1-year outcomes revealed no differences between younger versus elderly patients with regard to functional or HRQoL scores (e.g. total QOLIBRI 77.4 ± 20.0 and 75.6 ± 18.1, resp.). Univariate analysis showed no correlation of the total QOLIBRI with age (Pearson r = − 0.09) or trauma severity (AIS) of the head (r = − 0.05). Multivariate analysis confirmed an association of age 80 or older (R2 = 0.026, p = 0.029), but not of overall age (R2 = 0.004, p = 0.218) with 1-year outcome scores on the total QOLIBRI.

Conclusions

Given the rising rehabilitation demands of the elderly these pilot findings call for the utilisation of specific outcome scores such as the QOLIBRI in this age group as well, at least up to an age of 80 years and independently of the severity of TBI sustained.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Tsyben A, Guilfoyle M, Timofeev I et al (2018) Spectrum of outcomes following traumatic brain injury—relationship between functional impairment and health-related quality of life. Acta Neurochir 160(1):107–115

    Article  PubMed  Google Scholar 

  2. Hofhuis JGM, Spronk PE (2014) Health-related quality of life and influence of age after trauma: an overview. J Trauma Acute Care Surg 76(2):549–556

    Article  PubMed  Google Scholar 

  3. Dijkers M, Brandstater M, Horn S, Ryser D, Barrett R (2013) Inpatient rehabilitation for traumatic brain injury: the influence of age on treatments and outcomes. NeuroRehabilitation 32:233–252

    PubMed  Google Scholar 

  4. Granger CV, Markello SJ, Graham JE, Deutsch A, Reistetter TA, Ottenbacher KJ (2010) The uniform data system for medical rehabilitation report of patients with traumatic brain injury discharged from rehabilitation programs in 2000–2007. Am J Phys Med Rehabil Assoc Acad Physiatr 89(4):265–278

    Article  Google Scholar 

  5. Neugebauer E, Lefering R, Bouillon B, Bullinger M, Wood-Dauphinée S (2002) Quality of life after multiple trauma. Aim and scope of the conference. Restor Neurol Neurosci 20(3):87–92

    PubMed  CAS  Google Scholar 

  6. Siponkoski ST, Wilson L, von Steinbuechel N, Sarajuuri J, Koskinen S (2013) Quality of life after traumatic brain injury: Finnish experience of the QOLIBRI in residential rehabilitation. J Rehabil Med 45:835–842

    Article  PubMed  Google Scholar 

  7. Nichol AD, Higgins AM, Gabbe BJ, Murray LJ, Cooper DJ, Cameron PA (2011) Measuring functional and quality of life outcomes following major head injury: common scales and checklists. Injury 42(3):281–287

    Article  PubMed  CAS  Google Scholar 

  8. von Steinbuechel N, Wilson L, Gibbons H et al (2010) Quality of Life after brain injury (QOLIBRI): scale development and metric properties. J Neurotrauma 27(7):1167–1185

    Article  Google Scholar 

  9. Truelle JL, Koskinen S, Hawthorne G et al (2010) Quality of life after traumatic brain injury: the clinical use of the QOLIBRI, a novel disease-specific instrument. Brain Inj 24(11):1272–1291

    Article  PubMed  Google Scholar 

  10. von Steinbuechel N, Covic A, Polinder S et al. (2016) Assessment of health-related quality of life after TBI: comparison of a disease-specific (QOLIBRI) with a generic (SF-36) instrument. Behav Neurol 2016;2016:7928014

    Google Scholar 

  11. Giustini M, Longo E, Azicnuda E et al (2014) Health-related quality of life after traumatic brain injury: Italian validation of the QOLIBRI. Funct Neurol 29(3):167–176

    PubMed  PubMed Central  Google Scholar 

  12. American College of Surgeons Committee on T (2012) Advanced trauma life support (ATLS) student course manual. American College of Surgeons, Chicago

    Google Scholar 

  13. Neugebauer EAM, Waydhas C, Lendemans S, Rixen D, Eikermann M, Pohlemann T (2012) The treatment of patients with severe and multiple traumatic injuries. Deutsches Ärzteblatt International 109(6):102–108

    PubMed  PubMed Central  Google Scholar 

  14. Gennarelli T (1990) The abbreviated injury scale—1990 revision. American Association for the Advancement of Automotive Medicine (AAAM), Des Plaines

    Google Scholar 

  15. Masson F, Thicoipe M, Aye P et al (2001) Epidemiology of severe brain injuries: a prospective population-based study. J Trauma Inj Infect Crit Care 51:481–489

    Article  CAS  Google Scholar 

  16. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. Lancet 7905:480–484

    Article  Google Scholar 

  17. Teasdale G, Jennett B (1976) Assessment and prognosis of coma after head injury. ActaNeurochirurgica 34:45–55

    CAS  Google Scholar 

  18. Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma Inj Infect Crit Care 14(3):187–196

    Article  CAS  Google Scholar 

  19. Sutherland AG, Johnston AT (2006) The new injury severity score: better prediction of functional recovery after musculoskeletal injury. Value Health 9(1):24–27

    Article  PubMed  Google Scholar 

  20. Lefering R (2009) Development and validation of the revised injury severity classification score for severely injured patients. Eur J Trauma Emerg Surg 5(35):437–447

    Article  Google Scholar 

  21. Szende A, Williams A (2004) Measuring self-reported population health: an international perspective based on EQ-5D. Springer Med Publishing Ltd., Budapest

    Google Scholar 

  22. Bullinger M (1995) German translation and psychometric testing of the SF-36 health survey: preliminary results from the IQOLA project. Soc Sci Med 41(10):1359–1366

    Article  PubMed  CAS  Google Scholar 

  23. Pirente N, Gregor A, Bouillon B, Neugebauer E (2001) Quality of life of severely injured patients one year after trauma. A matched-pair study with a healthy control group. Unfallchirurg, 104:57–63

    Article  PubMed  CAS  Google Scholar 

  24. Attenberger C, Amsler F, Gross T (2012) Clinical evaluation of the trauma outcome profile (TOP) in the longer-term follow-up of polytrauma patients. Injury 43:1566–1574

    Article  PubMed  Google Scholar 

  25. von Steinbuechel N, Wilson L, Gibbons H et al (2010) Quality of life after brain injury (QOLIBRI): scale validity and correlates of quality of life. J Neurotrauma 27(7):1157–1165

    Article  Google Scholar 

  26. Platts-Mills TF, Evans CS, Brice JH (2016) Prehospital triage of injured older adults: thinking slow inside the golden hour. J Am Geriatr Soc 64:1941–1943

    Article  PubMed  Google Scholar 

  27. Pirente N, Ottlik Y, Lefering R, Bouillon B, Neugebauer EAM, the Working Group “Polytrauma” of the DGU (2006) Quality of life in multiply injured patients—development of the trauma outcome profile (TOP) as part of the modular polytrauma outcome (POLO) chart. Eur J Trauma 32:44–62

    Article  Google Scholar 

  28. Pagulayan KF, Temkin NR, Machamer JE, Dikmen SS (2006) A longitudinal study of health-related quality of life after traumatic brain injury. Arch Phys Med Rehabil 87(5):611–618

    Article  PubMed  Google Scholar 

  29. Gross T, Schüepp M, Attenberger C, Pargger H, Amsler F (2012) Outcome in polytraumatized patients with and without brain injury. Acta Anaesthesiol Scand 56(9):1163–1174

    Article  PubMed  CAS  Google Scholar 

  30. Cassidy JD, Cancelliere C, Carroll LJ et al (2014) Systematic review of self-reported prognosis in adults after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 95(3):S132-S151

    Google Scholar 

  31. Wilde EA, Whiteneck GG, Bogner J et al (2010) Recommendations for the use of common outcome measures in traumatic brain injury research. Arch Phys Med Rehabil 91(11):1650–1660

    Article  PubMed  Google Scholar 

  32. Polinder S, Haagsma JA, van Klaveren D, Steyerberg EW, Van Beeck EF (2015) Health-related quality of life after TBI: a systematic review of study design, instruments, measurement properties, and outcome. Popul Health Metr 13:4

    Article  PubMed  PubMed Central  Google Scholar 

  33. Grauwmeijer E, Heijenbrok-Kal MH, Ribbers GM (2014) Health-related quality of life 3 years after moderate to severe traumatic brain injury: a prospective cohort study. Arch Phys Med Rehabil 95:1268–1276

    Article  PubMed  Google Scholar 

  34. Scholten AC, Haagsma JA, Andriessen T et al (2015) Health-related quality of life after mild, moderate and severe traumatic brain injury: Patterns and predictors of suboptimal functioning during the first year after injury. Injury 46(4):616–624

    Article  PubMed  CAS  Google Scholar 

  35. von Steinbüchel N, Real RGL, Sasse N et al (2017) German validation of quality of life after brain injury (QOLIBRI) assessment and associated factors. PLoS ONE 12(5):e0176668

    Article  CAS  Google Scholar 

  36. Teasdale TW, Engberg AW (2005) Subjective well-being and quality of life following traumatic brain injury in adults: A long-term population-based follow-up. Brain Inj 19(12):1041–1048

    Article  PubMed  CAS  Google Scholar 

  37. Dikmen SS, Machamer JE, Powell JM, Temkin NR (2003) Outcome 3 to 5 years after moderate to severe traumatic brain injury. Arch Phys Med Rehabil 84(10):1449–1457

    Article  PubMed  Google Scholar 

  38. Carroll LJ, Cassidy JD, Cancelliere C et al (2014) Systematic review of the prognosis after mild traumatic brain injury in adults: cognitive, psychiatric, and mortality outcomes: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Arch Phys Med Rehabil 95(3):S152–S173

    Article  PubMed  Google Scholar 

  39. Kehoe A, Smith JE, Bouamra O, Edwards A, Yates D, Lecky F (2016) Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 33(6):381–385

    Article  PubMed  CAS  Google Scholar 

  40. Hawthorne G, Kaye AH, Gruen R, Houseman D, Bauer I (2011) Traumatic brain injury and quality of life: initial Australian validation of the QOLIBRI. J Clin Neurosci 18(2):197–202

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors are grateful for the commitment of L. Meier, F. Maeder, M. Keller and S. Morell in collecting original data, the editorial assistance of J. Buchanan and thank all the patients and interdisciplinary hospital collaborators involved in the study.

Funding

The study was financially supported by the Research Fund of the hospital.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Gross.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Ethical approval

The study has been approved by the regional ethics committee and has been performed in accordance with the ethical standards laid down in the Declaration of Helsinki.

Informed consent

All persons gave their informed consent prior to their inclusion in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gross, T., Amsler, F. One-year outcome following brain injury: a comparison of younger versus elderly major trauma patients. Arch Orthop Trauma Surg 138, 1375–1387 (2018). https://doi.org/10.1007/s00402-018-2974-1

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-018-2974-1

Keywords

  • Traumatic brain injury (TBI)
  • Major trauma
  • Age
  • Quality of Life after Brain Injury (QOLIBRI)
  • Health-related quality of life (HRQol)
  • Outcome