Trajectory of disability and quality-of-life in non-geriatric and geriatric survivors after severe traumatic brain injury

<i>Objective</i>: The objective was to investigate disability and health-related quality-of-life (HRQoL) 3, 6 and 12 months after traumatic brain injury (TBI) in non-geriatric (≤ 65 years) and geriatric patients (&gt; 65 years). <i>Methods</i>: Patients ≥ 16 years who sustained a severe TBI (Abbreviated Injury Scale of the head region &gt; 3) were included in this prospective, multi-centre study. Outcome measures were Glasgow Outcome Scale Extended (GOSE; disability), SF-12 (HRQoL). Mixed linear model analyses were performed. <i>Results</i>: Three hundred and fifty-one patients (median age = 50 years; interquartile range (IQR) = 27–67) were included; 73.2% were male and 27.6% were geriatric patients. Median GOSE at 3, 6 and 12 months was 5 (IQR = 3–7), 6 (IQR = 4–8) and 7 (IQR = 5–8); this increase (slope_time = 0.22, <i>p</i> &lt; 0.0001) was age dependent (slope_age*time = –0.06, <i>p</i> = 0.003). Median SF-12 physical component scale score at 3, 6 and 12 months was 42.1 (IQR = 33.6–50.7), 46.6 (IQR = 37.4–53.9) and 50.4 (IQR = 39.2–55.1); this increase (slope_time = 1.52, <i>p &lt;</i> 0.0001) was not age dependent (slope_age*time = –0.30, <i>p</i> = 0.083). SF-12 mental component scale scores were unchanged. <i>Conclusions</i>: Disability decreased and HRQoL improved after TBI between 3–12 months. In geriatric patients this improvement was relevant for HRQoL only.

【研究目标】本研究旨在探究年龄≤65岁的非老年患者与年龄>65岁的老年患者在创伤性脑损伤（traumatic brain injury, TBI）后3、6及12个月时的伤残情况与健康相关生存质量（health-related quality-of-life, HRQoL）。
【研究方法】本项前瞻性多中心研究纳入了年龄≥16岁、罹患重度创伤性脑损伤（头部简明损伤定级标准（Abbreviated Injury Scale, AIS）评分>3）的患者。本研究的结局指标包括扩展格拉斯哥结局量表（Glasgow Outcome Scale Extended, GOSE，用于评估伤残程度）与SF-12健康调查量表（用于评估HRQoL），并采用混合线性模型（mixed linear model）进行数据分析。
【研究结果】本研究共纳入351例患者，年龄中位数为50岁，四分位距（interquartile range, IQR）为27~67岁；其中男性占比73.2%，老年患者占比27.6%。在伤后3、6及12个月时，GOSE评分中位数分别为5（IQR=3~7）、6（IQR=4~8）与7（IQR=5~8）；该评分随时间呈上升趋势（时间斜率=0.22，*p*<0.0001），且该趋势存在年龄依赖性（年龄×时间交互斜率=-0.06，*p*=0.003）。SF-12躯体分量表评分在伤后3、6及12个月的中位数分别为42.1（IQR=33.6~50.7）、46.6（IQR=37.4~53.9）与50.4（IQR=39.2~55.1）；该评分随时间呈上升趋势（时间斜率=1.52，*p*<0.0001），且该趋势无显著年龄依赖性（年龄×时间交互斜率=-0.30，*p*=0.083）。SF-12精神分量表评分则无明显变化。
【研究结论】创伤性脑损伤患者在伤后3~12个月期间，伤残程度逐渐降低，健康相关生存质量显著改善。对于老年患者而言，此类改善仅与健康相关生存质量相关。