Assessment of clinical, functional and psychological outcome after 6 months of moderate and severe TBI

Sixty consecutive participants aged 18 and above with moderate to severe TBI (GCS score of 3-12 at admission) attending the Outpatient Department of Neurosurgery Specialty, Post Graduate Institute of Medical Education and Research, Chandigarh, India were recruited. The exclusion criteria were any pre-existing major psychiatric disorders, intellectual disability, current or past history of substance abuse, degenerative and/or progressive condition, terminal illness and past history of TBI. Ethical clearance was obtained from Institute Ethics Committee. Written informed consent was obtained from all participants prior to inclusion in the study. Socio-demographic details (age, sex, marital status, family type, place of residence, education and occupation) and clinical details (mode of injury, injury severity, treatment, status on discharge, any previous co morbidities) were obtained from participant and hospital records. Functional outcome was assessed by Glasgow Outcome Scale and Barthel’s Index of Activities of Daily Living. Mini Mental State Examination (MMSE) was used to assess cognitive status. Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression.

Out of 60 patients, 40 had moderate head injury and 20 patients had suffered from severe head injury. There were 53 male (88.3%) and 7 (11.7%) female and the mean age was 34 years (SD=14.5). The mean duration of TBI was 11 months (SD=6.5). Fifty percent participants were married and majority was living in joint/extended families. Majorities were residing in rural localities 36 (60%). With regard to education level 11.7% were illiterate, 33% were educated up to 10th standard and 21.7% up to 12th standard. With regard to occupation, 11.7% were unemployed, 6.7% were housewives, 11.7% were students, 8.3% were retired and rest (61.6%) was engaged in varied occupations.

The most common mode of injury was road traffic accident (90%). Contusion was the most common CT abnormality noted (37 patients, 61.7%). Regarding treatment, 36 patients (60%) underwent surgical intervention and 24 (40%) were managed conservatively. With regard to surgical intervention, 28 (77.8 %) patients underwent decompressive hemicraniectomy and subsequent cranioplasty and rest 8 (22.2 %) underwent craniotomy and hematoma evacuation. As per Glasgow Outcome Scale, 50 (83%) had low disability and 10 (17%) had moderate to severe disability. The mean Barthel’s Index score was 19.6+1.07 (Range 15-20) which indicated that most of the patients had resumed independence in activities of daily living. Only 25% participants were observed to have cognitive impairment (MMSE). With regard to anxiety and depression 16.7% showed symptoms of anxiety whereas 30% showed symptoms of depression (HADS score >8).

After 6 months of TBI, most participants had resumed independence in activities of daily living but cognitive impairment is persistent in 25% and symptoms of depression in 30% participants.

To assess the impact of injury severity on disease specific quality of life after Traumatic Brain Injury

The study was carried out in Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India after obtaining ethical clearance from Institute Ethics Committee. Sixty consecutive patients aged 18 and above with moderate to severe TBI (GCS score of 3-12 at admission) attending the Outpatient Department of Neurosurgery Specialty were screened. Out of 60 participants, 40 had moderate TBI (GCS 9-12) and 20 patients had severe TBI (GCS 3-8). The participants having any pre-existing major psychiatric disorders, intellectual disability, current or past history of substance abuse, degenerative and/or progressive condition, terminal illness and past history of TBI were excluded. Written informed consent was obtained from each participant. Socio-demographic details and information about clinical status at the time of admission and discharge were obtained from participant and hospital records. Disease specific quality of life was measured by QOLIBRI (Quality of life after brain injury). It is a self-reported measure comprising of 37 items. The first part assesses the subjects’ satisfaction with his HRQL in 4 domains (cognition, self, daily life and autonomy, and social relationships). The second part measures how much the subject is bothered after TBI in 2 domains (emotions and physical problems). The other tools administered were Glasgow Outcome Scale and Barthel’s Index of Activities of Daily Living (functional status); Mini Mental State Examination (cognitive status): Hospital Anxiety and Depression Scale (anxiety and depression).

The data was analyzed using statistical package for social sciences software version 21 (SPSS). There were no significant differences between both groups with regard to age, gender, education status, marital status, family type and place of residence. Both groups were similar with regard to mode of injury and duration of injury. With regard to treatment during admission both group had significant differences. Among severe TBI group 90% underwent surgical intervention whereas among moderate TBI group only 45% underwent surgical intervention. Significant difference was present in GCS score at discharge between both the groups. After 6 months of injury both group had no significant difference with regard to functional status, global cognitive functioning, anxiety and depression. With regard to quality of life significant difference emerged between the groups on QOLIBRI total score. On various subscales of QOLIBRI - significant differences were noted only in the domains of social relationship and emotions. There were no differences between them on domains of cognition, self, daily life and physical problems.

After 6 months of TBI, the participants in both groups (Moderate TBI and severe TBI) had similar functioning with regard to daily activities and psychological functioning. With regard to quality of life both groups emerged to be significantly different on overall quality of life and domains of social relationship and emotions.