Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury

Aim. To assess the clinical course of disability, cognitive, and emotional impairments in patients with severe TBI (s-TBI) from 3 months to up to 7 years post trauma. Methods. A prospective cohort study of s-TBI in northern Sweden was conducted. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Glasgow Outcome Scale Extended (GOSE), the Hospital Anxiety and Depression Scale (HADS), and the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) at 3 months, 1 year, and 7 years after the injury. Results. The scores on both GOSE and BNIS improved significantly from 3 months (GOSE mean: 4 4±2 3, BNIS mean: 31 5±7 0) to 1 year (GOSE mean: 5 5±2 7, p = 0 003, BNIS mean: 33 2 ± 6 3, p = 0 04), but no significant improvement was found from 1 year to 7 years (GOSE mean: 4 7±2 8, p = 0 13, BNIS mean: 33 5±3 9, p = 0 424) after the injury. The BNIS subscale “speech/language” at 1 year was significantly associated with favourable outcomes on the GOSE at 7 years (OR = 2 115, CI: 1.004-4.456, p = 0 049). Conclusions. These findings indicate that disability and cognition seem to improve over time after s-TBI and appear to be relatively stable from 1 year to 7 years. Since cognitive function on some of the BNIS subscales was associated with outcome on the GOSE, these results indicate that both screening and follow-up of cognitive function could be of importance for the rehabilitation of persons with s-TBI.