Functional outcome scales in traumatic brain injury: a comparison of the Glasgow Outcome Scale (Extended) and the Functional Status Examination.
ABSTRACT Clinical trials aimed at developing therapies for traumatic brain injury (TBI) require outcome measures that are reliable, validated, and easily administered. The most widely used of these measures, the Glasgow Outcome Scale (GOS) and the GOS-Extended (GOS-E), have been criticized as suffering from ceiling effects. In an attempt to develop a more useful and dynamic outcome measure, the Functional Status Examination (FSE) was developed, which grades outcome across 10 functional domains. The FSE has been demonstrated to be reliable and sensitive in monitoring recovery after TBI. This manuscript compares FSE with GOS-E in a cohort of patients with a wide range of injury severities. 177 individuals who survived at least 6 months after TBI were studied. The FSE and GOS-E were administered 6-12 months after injury. FSE and GOS-E scores correlated well with each other. FSE scores were distributed throughout the range, indicating that ceiling and floor effects were not present. Physiologic measures of injury severity (Glasgow Coma Score [GCS]) did not correlate with anatomic measures (Abbreviated Injury Scale [AIS] and Injury Severity Score [ISS]). GCS correlated weakly with both outcome measures, but AIS/ISS did not. We conclude that FSE and GOS-E are reliable outcome measures for TBI survivors, and FSE may offer some advantages over GOS-E due its ability to provide a more detailed description of deficits. The majority of the variance in outcome is not accounted for by currently available measures of injury severity.
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ABSTRACT: Major trauma is the leading cause of death in children of developed countries. However, little is known about its long-term health consequences in survivors. Our aim was to describe the health condition in children at long-term after major trauma. Prospective cohort study of severely injured children (Injury Severity Score > or =16, age <16) admitted to a Dutch level I trauma center in 1999 to 2000 (N = 40). About 7 years after trauma (median, 7.3; range, 6.3-8.2 years), survivors' health condition was assessed with the following: guides to the evaluation of permanent impairment of the American Medical Association (AMA-guides), Glasgow Outcome Scales (GOS/GOSE), Vineland Adaptive Behavior Scales (VABS), Child Behavior Checklist (CBCL), and Strengths and Difficulties Questionnaire (SDQ). Of 40 children, 28 were followed up. Most (n = 16; 57%) had no impairments (AMA guides); minor to severe impairments were found in 12 of the respondents. About 80% (n = 22) had good recovery (GOS 5 and GOSE 7/8); the remaining had moderately disability (GOS 4 or GOSE 5/6). The mean scores on the VABS and the frequency of behavioral problems on the CBCL (24%) and the SDQ (20%) were comparable to healthy peers. This long-term follow-up study after major trauma revealed that most children had a health condition comparable to healthy peers; about 40% of the respondents was physically impaired or restricted in daily activities. Our experiences with different measures may be helpful to apply age-appropriate outcome measures for the clinical follow-up of children after major trauma and to design future longitudinal studies.Journal of Pediatric Surgery 08/2009; 44(8):1591-600. DOI:10.1016/j.jpedsurg.2009.02.054 · 1.31 Impact Factor
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ABSTRACT: PurposeMajor trauma is the leading cause of death in children of developed countries. However, little is known about its long-term health consequences in survivors. Our aim was to describe the health condition in children at long-term after major trauma.
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ABSTRACT: Traumatic brain injury (TBI) is a pathologically heterogeneous disease, including injury to both neuronal cell bodies and axonal processes. Global atrophy of both gray and white matter is common after TBI. This study was designed to determine the relationship between neuroimaging markers of acute diffuse axonal injury (DAI) and cerebral atrophy months later. We performed high-resolution magnetic resonance imaging (MRI) at 3 Tesla (T) in 20 patients who suffered non-penetrating TBI, during the acute (within 1 month after the injury) and chronic stage (at least 6 months after the injury). Volume of abnormal fluid-attenuated inversion-recovery (FLAIR) signal seen in white matter in both acute and follow-up scans was quantified. White and gray matter volumes were also quantified. Functional outcome was measured using the Functional Status Examination (FSE) at the time of the chronic scan. Change in brain volumes, including whole brain volume (WBV), white matter volume (WMV), and gray matter volume (GMV), correlates significantly with acute DAI volume (r = -0.69, -0.59, -0.58, respectively; p <0.01 for all). Volume of acute FLAIR hyperintensities correlates with volume of decreased FLAIR signal in the follow-up scans (r = -0.86, p < 0.001). FSE performance correlates with acute hyperintensity volume and chronic cerebral atrophy (r = 0.53, p = 0.02; r = -0.45, p = 0.03, respectively). Acute axonal lesions measured by FLAIR imaging are strongly predictive of post-traumatic cerebral atrophy. Our findings suggest that axonal pathology measured as white matter lesions following TBI can be identified using MRI, and may be a useful measure for DAI-directed therapies.Journal of Neurotrauma 12/2008; 25(12):1433-40. DOI:10.1089/neu.2008.0683 · 3.97 Impact Factor