Measuring outcome after severe TBI

To review current scales for measuring outcome following traumatic brain injury (TBI) and discuss changes in the types and use of these scales for the purposes of facilitating comparative effectiveness research.

Functional, psychosocial/neurocognitive, and quality of life (QOL) scales used for assessing outcome following TBI are presented, along with the limitations of each. Core common data element scales are noted, and parametric, preference-based scales for performing comparative effectiveness research are discussed.

Many of the common outcome scales used in TBI research, including the Glasgow outcome scale (GOS), are functional measures. The emotional, cognitive, and psychosocial aspects of recovery are increasingly recognised, and metrics assessing these domains are becoming more common. Quality of life scales, which can be either directly used or translated into parametric preference-based indices for comparative effectiveness research are important for assessing patient-oriented outcomes, and in the upcoming years may yield information that improves medical decision-making, and ultimately outcomes following TBI.

Traumatic brain injury disrupts normal physical, cognitive, emotional, and social processes. Despite the dominance of functional scales like the GOS in the neurosurgical and neurocritical care literature, the use of other outcome modalities, including emotional, cognitive, psychosocial, and health-related QOL domains will be essential to improve patient care in the future.