Global outcome, productivity and epilepsy 3-8 years after severe head injury. The impact of injury severity

Objective: To assess long-term outcome in survivors after severe head injury and relate outcome to injury severity. Design: Follow-up 3-8 years post injury in a retrospectively collected sample. Setting: A neurosurgical department in a regional trauma centre. Subjects: Of 146 individuals admitted, 135 were actively treated. Twenty-four per cent of these died within six months. Ninety-three of the 94 (aged 1-88 years) who survived more than three years were included in the follow-up. They were separated into groups based on their level of consciousness at four weeks post injury: oriented (n=39), confused (n=22) or in a minimally conscious/vegetative state (MCS/VS) (n=26) and not possible to assess (n=6). Outcome measures: Glasgow Outcome Scale Extended (GOSE), participation in work/education (productivity) and posttraumatic epilepsy. Results: GOSE scores were: vegetative state: 3%, severe disability: 28% (22% lower level, 6% upper level), moderate disability: 39% (22% lower level, 17% upper level) and good recovery: 27% (10% lower level, 17% upper level). Productivity was 34% (aged 7-64 years). The three severity groups had different GOSE scores (P < 0.001) and different proportion of productive individuals (P < 0.001). Twenty-three per cent experienced posttraumatic epilepsy and this was significantly associated with the highest injury severity (P < 0.001) and intracranial surgery (P=0.01). Conclusions: Being independent in daily life but unable to work was the typical long-term outcome. Stratifying the patients based on consciousness at four weeks we found different outcomes. Among oriented patients, almost all regained independency, whereas in the most severe group, poor outcomes and posttraumatic epilepsy was common.