Personal Injury Law

Mild TBI and Long Term Disability

By Bruce Stern

Last week I discussed the presentation of Sir Graham Teasdale at the IBIA World Congress on Brain Injury. Dr. Teasdale reported on his findings after following a large group of patients who suffered a traumatic brain injury. Below are his published findings after following this group for 5-7 years. This is from the abstract:

Disability in young people and adults after head injury:
5–7 year follow up of a prospective cohort study
L Whitnall, T M McMillan, G D Murray, G M Teasdale
J Neurol Neurosurg Psychiatry 2006;77:640–645. doi: 10.1136/jnnp.2005.078246

Background: Improvement 1–2 years after head injury is well established but the pattern thereafter is unclear. Past studies have not examined representative head injury populations and typically report findings in terms of functioning across social, psychological, neurobehavioural, or cognitive domains rather than global outcome.

Objective: To determine the late outcome of a representative cohort of participants admitted to hospital after a head injury 5–7 years previously and to identify early and late factors correlating with persisting disability and change between one and 5–7 years.

Methods: A representative cohort of head injured people whose outcome one year after injury was reported previously, were followed up 5–7 years after injury. Participants were assessed using structured and validated measures of global outcome (Glasgow Outcome Scale Extended), cognitive impairment, psychological wellbeing, health status, and social factors.

Results: Of 475 survivors studied at one year, 115 (24%) had died by seven years. In survivors at 5–7 years, disability remained frequent (53%); and the rate, similar to that found at one year (57%). Sixty three participants (29%) had improved but 55 (25%) deteriorated. The persistence of disability and its development after previous recovery each showed stronger associations with indices of depression, anxiety, and low self-esteem than with initial severity of injury or persisting cognitive impairment.

Conclusions: Admission to hospital after head injury is followed 5–7 years later by disability in a high proportion of survivors. Persistence of disability and development of new disability are strongly associated with psychosocial factors that may be open to remediation, even late after injury.

What is really important for neurolawyers is this. Most survivors who were disabled at a year remained disabled . Some participants who were disabled at 1 year had improved to a state of good recovery at 5–7 years but these were counterbalanced by a decline in outcome in some considered to have recovered well at one year. In conclusion, admission to hospital, even after what was judged conventionally to be a minor head injury, is followed 5–7 years later by disability in a high proportion of survivors. Both persistence of disability and the development of new
disability are associated strongly with psychosocial factors that may be open to remediation, even late after injury.

Full post as published by Traumatic Brain Injury Law Blog on March 16, 2010 (boomark / email).