2013 http://informahealthcare.com/bij ISSN: 0269-9052 (print), 1362-301X (electronic) Brain Inj, Early Online: 1–8 ! 2013 Informa UK Ltd. DOI: 10.3109/02699052.2013.794971 ORIGINAL ARTICLE Predictive factors for 1-year outcome of a cohort of patients with severe traumatic brain injury (TBI): Results from the PariS-TBI study C. Jourdan 1,2,3 , V. Bosserelle 4,5 , S. Azerad 4,5 , I. Ghout 5 , E. Bayen 3,6,7 , P. Aegerter 2,5 , J. J. Weiss 4 , J. Mateo 8 , T. Lescot 9 , B. Vigue ´ 10 , K. Tazarourte 11 , P. Pradat-Diehl 3,6,7 , P. Azouvi 1,2,3 , & the members of the steering committee of the PariS-TBI study 1 Service de Me ´decine Physique et de Re ´adaptation, APHP Ho ˆpital Raymond Poincare ´, Garches, France, 2 Universite ´ de Versailles – Saint-Quentin en Yvelines, Versailles, France, 3 Unite ´ ER 6 UPMC, Paris, France, 4 Centre Ressources Francilien du Traumatisme Cra ˆnien (CRFTC), APHP Ho ˆpital Broussais, Paris, France, 5 Unite ´ de Recherche Clinique (URC), APHP Ho ˆpital A Pare ´, Boulogne, France, 6 Universite ´ Pierre et Marie Curie, Paris, France, 7 Service de Me ´decine Physique et Re ´adaptation, APHP Groupe Hospitalier Pitie ´-Salpe ˆtrie `re, Paris, France, 8 De ´partement d’Anesthe ´siologie, Soins intensifs & SAMU, APHP Ho ˆpital Lariboisie `re, Paris, France, 9 De ´partement d’Anesthe ´siologie, Soins intensifs, APHP Groupe Hospitalier Pitie ´- Salpe ˆtrie `re, Paris, France, 10 De ´partement d’Anesthe ´siologie & Soins intensifs, APHP Ho ˆpital Bice ˆtre, Le Kremlin Bice ˆtre, France, and 11 SAMU 77, Mobile Care Unit, Ho ˆpital Marc Jacquet, Melun, France Abstract Objectives: To assess outcome and predicting factors 1 year after a severe traumatic brain injury (TBI). Methods: Multi-centre prospective inception cohort study of patients aged 15 or older with a severe TBI in the Parisian area, France. Data were collected prospectively starting the day of injury. One-year evaluation included the relatives-rating of the Dysexecutive Questionnaire (DEX-R), the Glasgow Outcome Scale–Extended (GOSE) and employment. Univariate and multivariate tests were computed. Results: Among 257 survivors, 134 were included (mean age 36 years, 84% men). Good recovery concerned 19%, moderate disability 43% and severe disability 38%. Among patients employed pre-injury, 42% were working, 28% with no job change. DEX-R score was significantly associated with length of education only. Among initial severity measures, only the IMPACT prognostic score was significantly related to GOSE in univariate analyses, while measures relating to early evolution were more significant predictors. In multivariate analyses, independent predictors of GOSE were length of stay in intensive care (LOS), age and education. Independent predictors of employment were LOS and age. Conclusions: Age, education and injury severity are independent predictors of global disability and return to work 1 year after a severe TBI. Keywords Brain injury, craniocerebral trauma, disability, dysexecutive questionnaire, outcome History Received 28 August 2012 Revised 26 March 2013 Accepted 7 April 2013 Published online 30 May 2013 Introduction Traumatic brain injury (TBI) is a leading cause of death and disability worldwide and its global incidence is rising [1]. TBI epidemiology is in constant evolution, as the incidence of TBI related to road traffic accidents decreases in high-income countries, while falls in the ageing population are becoming more prevalent [1]. Intensive care and monitoring of injury have also evolved dramatically in the past years. Prospective epidemiological data need thus to be continuously updated and validated [2]. Several large-scale prospective studies [3, 4] have increased the knowledge on early evolution of patients with TBI and produced validated predictive models based on admission characteristics. These studies offer prognosis scores to predict death or unfavourable outcome as defined by the Glasgow Outcome Scale (GOS) [5], which is a five- level rating scale of survival and global disability. These scores have good accuracy for 6-month outcome, but their value in predicting later outcome needs to be determined. Predictors of late outcome are more diverse, as they include trauma characteristics and severity [6], but also early evolution parameters, motor and cognitive impairments [7], socio-demographic characteristics [8] and environmental factors [9]. Cohort studies yield conflicting results regarding predictors of 1-year outcome [8, 10, 11], owing to the multiplicity of outcome measures and prognosis factors [8], which are often inter-related [12]. Improving the accuracy of late outcome prediction is essential to inform patients and families about the Correspondence: Professor Philippe Azouvi, Service de Me ´decine Physique et de Re ´adaptation, Ho ˆpital Raymond Poincare ´, 104, bd Raymond Poincare ´, 92380, Garches, France. Tel: + (33)1 47107082. Fax: + (33)1 47107726. Email: philippe.azouvi@rpc.aphp.fr Brain Inj Downloaded from informahealthcare.com by Prof P. Azouvi on 06/04/13 For personal use only.