Traumatic Brain Injury: Severity and Outcome

  • B. van Baalen
  • E. Odding
  • A. I. R. Maas


Traumatic brain injury (TBI) has been termed a silent epidemic [1]. In the USA, approximately 95 per 100 000 inhabitants sustain a fatal, or severe enough injury to require hospital admission, each year [2]. In the Federal Republic of Germany, the annual incidence of severe TBI is estimated at 10000 [3]. In the Netherlands, the incidence is 79 per 100 000 inhabitants [4]. Whilst this incidence is lower, compared to other causes of brain injury, such as stroke, the long-term effects and socio-economic costs are equal or even higher, as TBI primarily affects younger age groups.


Traumatic Brain Injury Head Injury Glasgow Coma Scale Severe Traumatic Brain Injury Glasgow Outcome Scale 
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  1. 1.
    Goldstein M (1990) Traumatic brain injury: A silent epidemic. Ann Neurol 27: 327PubMedCrossRefGoogle Scholar
  2. 2.
    National Center for Injury Prevention and Control (1999) Epidemiology of traumatic brain injury in the United States. At:
  3. 3.
    Lehr D, Baethmann A, Reulen HJ, et al (1997) Management of patients with severe head injury in the preclinical phase: A prospective analysis. J Trauma 42 (suppl 5): S71 - S75PubMedCrossRefGoogle Scholar
  4. 4.
    Van Balen HGG, Mulder Th, Keyser A (1996) Towards a disability-oriented epidmiology of traumatic brain injury. Disabil Rehabil 18: 181–190PubMedCrossRefGoogle Scholar
  5. 5.
    Hall KM, Johnston MV (1994) Outcomes evaluation in TBI rehabilitation. Part 2: measurement tools for a nationwide data system. Arch Phys Med Rehabil 75 (suppl):SC10–SC18PubMedCrossRefGoogle Scholar
  6. 6.
    Levin HS, O’Donnell VM, Grossman RG (1979) The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury. J Nery Ment Dis 167: 675–684CrossRefGoogle Scholar
  7. 7.
    Zafonte RD, Mann NR, Millis SR, Black KL, Wood DL, Hammond F (1997) Posttraumatic amnesia: Its relation to functional outcome. Arch Phys Med Rehabil 78: 1101–1106Google Scholar
  8. 8.
    Teasdale G, Jennet B (1974) Assessment of coma and impaired consciousness: a practical scale. The Lancet 2: 81–84CrossRefGoogle Scholar
  9. 9.
    Hall KM (1997) Establishing a national traumatic brain injury information system based upon a unified data set. Arch Phys Med Rehabil 78: 55–511CrossRefGoogle Scholar
  10. 10.
    Zasler ND (1997) Prognostic indicators in medical rehabilitation of traumatic brain injury: a commentary and review. Arch Phys Med Rehabil 78: S12 - S16PubMedCrossRefGoogle Scholar
  11. 11.
    Marshall LF, Marshall SB, Klauber MR, et al (1991) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 9 (suppl 1): S287 - S292Google Scholar
  12. 12.
    Aldrich EF, Eisenberg HM, Saydjari C, et al (1992) Predictors of mortality in severely head-injured patients civilian gunshot wounds: A report from the NIH Traumatic Coma Data Bank. Surg Neurol 38: 418–423PubMedCrossRefGoogle Scholar
  13. 13.
    Murray GD, Teasdale GM, Braakman R, et al (1999) The European Brain Injury Consortium survey of head injuries across Europe. Acta Neurochir (Wien) 141: 223–236CrossRefGoogle Scholar
  14. 14.
    World Health Organization (1980) International Classification of Impairments, Disabilities, and Handicaps. World Health Organization, GenevaGoogle Scholar
  15. 15.
    World Health Organization (1997) ICIDH-2: International Classification of Impairments, Activities and Participation. A manual of Dimensions of Disablement and Functioning. Beta-1 draft for field trials. World Health Organization, GenevaGoogle Scholar
  16. 16.
    Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. The Lancet 1: 480–485CrossRefGoogle Scholar
  17. 17.
    Anderson SI, Housley AM, Jones PA, Slattery J, Miller JD (1993) Glasgow Outcome Scale: an interrater reliability study. Brain Injury 7: 309–317PubMedCrossRefGoogle Scholar
  18. 18.
    Boake C (1996) Supervision Rating Scale: a measure of functional outcome from brain injury. Arch Phys Med Rehabil 77: 765–772PubMedCrossRefGoogle Scholar
  19. 19.
    Smith RM, Fields FRJ, Lenox JL, Morris HO, Nolan JJ (1979) A functional scale of recovery from severe head trauma. Clin Neuropsychol 1: 48–50Google Scholar
  20. 20.
    Maas AIR, Braakman R, Schouten HJA, Minderhoud JM, Van Zomeren AH (1983) Agreement between physicians on assessment of outcome following severe head injury. J Neurosurg 58: 321–325PubMedCrossRefGoogle Scholar
  21. 21.
    Livingston MG, Livingston HG (1985) The Glasgow Assessment Schedule: clinical and research assessment of head injury outcome. Int Rehabil Med 7: 145–149PubMedGoogle Scholar
  22. 22.
    Home G, Schremitsch E (1989) Assessment of the survivors of major trauma accidents. Aust N Z J Surg 59: 465–470CrossRefGoogle Scholar
  23. 23.
    Wilson JTL, Pettigrew LEL, Teasdale GM (1998) Structured interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale. J Neurotrauma 15: 587–597PubMedCrossRefGoogle Scholar
  24. 24.
    Jennett B, Snoek J, Bond MR, Brooks N (1981) Disability after severe head injury: Observations on the use of the Glasgow Outcome Scale. J Neurol Neurosurg Psych 44: 285–293CrossRefGoogle Scholar
  25. 25.
    Rappaport M, Hall KM, Hopkins K, Belleza T, Cope DN (1982) Disability Rating Scale for severe head trauma: coma to community. Arch Phys Med Rehabil 63: 118–123PubMedGoogle Scholar
  26. 26.
    Gouvier WD, Blanton PD, LaPorte KK, Nepomuceno C (1987) Reliability and validity of the Disability Rating Scale and the Levels of Cognitive Functioning Scale in monitoring recovery from severe head injury. Arch Phys Med Rehabil 68: 94–97PubMedGoogle Scholar
  27. 27.
    Heinemann, AW, Linacre JM, Wright BD, Hamilton BB, Granger C (1994) Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 75: 133–143PubMedCrossRefGoogle Scholar
  28. 28.
    Fleming JM, Maas F (1994) Prognosis of rehabilitation outcome in head injury using the disability rating scale. Arch Phys Med Rehabil 75: 156–163PubMedGoogle Scholar
  29. 29.
    Rappaport M, Hall K, Hopkins K, Belleza T, Berrol S, Reynolds G (1977) Evoked brain potentials and disability in brain-damaged patients. Arch Phys Med Rehabil 58: 333–338PubMedGoogle Scholar
  30. 30.
    Rappaport M, Hall K, Hopkins K, Belleza T (1981) Evoked potentials and head injury: 1. Rating of evoked potential abnormality. Clin Electroencephalogr 12: 154–166PubMedGoogle Scholar
  31. 31.
    Pettigrew LEL, Wilson JTL, Teasdale GM (1998) Assessing disability after head injury: improved use of the Glasgow Outcome Scale. J Neurosurg 89: 939–943PubMedCrossRefGoogle Scholar
  32. 32.
    Wade DT (1996) Measurement in Neurological Rehabilitation. Oxford University Press, OxfordGoogle Scholar
  33. 33.
    Collin C, Wade DT, Davis S, et al (1988) The Barthel ADL Index: a reliability study. Int Disabil Stud 10: 61–63PubMedCrossRefGoogle Scholar
  34. 34.
    Heyink J (1997) The Barthel Index. In: Hutchinson A, Bentzen N, König-Zahn C (eds) Cross Cultural Health Outcome Assessment: a User’s Guide. European Research Group on Health Outcomes, pp 99–103Google Scholar
  35. 35.
    Hagen C (1982) Language cognitive disorganization following closed head injury: a conceptualization. In: Trexler LE (ed) Cognitive Rehabilitation: Conceptualization and Intervention. Plenum Press, New York, pp 131–151CrossRefGoogle Scholar
  36. 36.
    Lezak MD (1995) Neuropsychological Assessment ( 3rd edn ). Oxford University Press, New YorkGoogle Scholar
  37. 37.
    Sohlberg MM, Mateer CA (1989) Introduction to Cognitive Rehabilitation. Guilford Press, New YorkGoogle Scholar
  38. 38.
    Granger CV, Hamilton BB, Keith RA, Zielezny M, Sherwin FS (1986) Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil 1: 59–74Google Scholar
  39. 39.
    Hamilton BB, Granger CV, Sherwin FS, et al (1987) A uniform national data system for medical rehabilitation. In: Fuhrer MJ (ed) Rehabilitation Outcomes: Analysis and Measurement. Brookes, Baltimore, pp 137–147Google Scholar
  40. 40.
    Hamilton BB, Laughlin JA, Granger CV, et al (1991) Interrater agreement of the seven level functional independence measure. Arch Phys Med Rehabil 72: 790Google Scholar
  41. 41.
    Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC (1996) The reliability of the functional independence measure: a quantitative review. Arch Phys Med Rehabil 77: 1226–1232PubMedCrossRefGoogle Scholar
  42. 42.
    Smith-Knapp K, Corrigan JD, Arnett JA (1996) Predicting functional independence from neuropsychological tests following traumatic brain injury. Brain Injury 10: 651–661PubMedCrossRefGoogle Scholar
  43. 43.
    Granger CV, Cotter AC, Hamilton BB, et al (1990) Functional assessment scales: study of persons with multiple sclerosis. Arch Phys Med Rehabil 71: 870–875PubMedGoogle Scholar
  44. 44.
    Granger CV, Cotter AC, Hamilton BB, et al (1993) Functional assessment scales: a study of persons after stroke. Arch Phys Med Rehabil 74: 133–138PubMedGoogle Scholar
  45. 45.
    Granger CV, Divan N, Roger BS, et al (1995) Functional assessment scales: a study of persons after traumatic brain injury. Am J Phys Med Rehabil 74: 107–113PubMedGoogle Scholar
  46. 46.
    Willer B, Rosenthal M, Kreutzer JS, Gordon WA, Rempel R (1993) Assessment of community integration following rehabilitation for traumatic brain injury. J Head Trauma Rehabil 8: 75–87CrossRefGoogle Scholar
  47. 47.
    Overall JE, Gorham DR (1962) The brief psychiatric rating scale. Psychol Rep 10: 799–812CrossRefGoogle Scholar
  48. 48.
    Levin HS, High WM, Goethe KE, et al (1987) The neurobehavioral rating scale: assessment of the behavioural sequelae of head injury by the clinician. J Neurol Neurosurg Psychiatry 50: 183–193PubMedCrossRefGoogle Scholar
  49. 49.
    Corrigan JD, Dickerson J, Fisher E, Meyer P (1990) The Neurobehavioural Rating Scale: replication in an acute, inpatient rehabilitation setting. Brain Injury 4: 215–222PubMedCrossRefGoogle Scholar
  50. 50.
    Powell JH, Beckers K, Greenwood RJ (1998) Measuring progress and outcome in community rehabilitation after brain injury with a new assessment instrument-the BICRO-39 scales. Arch Phys Med Rehabil 79: 1213–1225PubMedCrossRefGoogle Scholar
  51. 51.
    Berger E, Leven F, Pirente N, Boullon B, Neugebauer E (1999) Quality of life after traumatic brain injury: A systematic review of the literature. Restor Neurol Neurosci 14: 93–102PubMedGoogle Scholar
  52. 52.
    Pollard WE, Bobbit RA, Bergner M, Martin DP, Gilson BS (1976) The sickness impact profile: reliability of a health status measure. Med Care 14: 146–155PubMedCrossRefGoogle Scholar
  53. 53.
    Bergner M, Bobbitt RA, Kressel S, et al (1976) The Sickness Impact Profile: conceptual formulation and methodology for the development of a health status measure. Int J Health Sery 6: 393–415CrossRefGoogle Scholar
  54. 54.
    Krenz C, Larson EB, Buchner DM, Canfield CG (1988) Characterizing patient dysfunction in Alzheimer’s-Type dementia. Med Care 26: 453–461PubMedCrossRefGoogle Scholar
  55. 55.
    Hart CG, Evans RW (1987) The functional status of ESRD patients as measured by the Sickness Impact Profile. J Chron Dis 40: 1175–1305CrossRefGoogle Scholar
  56. 56.
    Dego R (1984) Pitfalls in measuring the health status of Mexican Americans: comparative validity of the English and Spanish Sickness Impact Profile. Am J Pub Health 74: 569–573CrossRefGoogle Scholar
  57. 57.
    Corrigan JD, Smith-Knapp K, Granger CV (1998) Outcomes in the first 5 years after traumatic brain injury. Arch Phys Med Rehabil 79: 298–230PubMedCrossRefGoogle Scholar
  58. 58.
    Smith JL, Magill-Evans J, Brintnell S (1998) Life satisfaction following traumatic brain injury. Can J Rehabil 11: 131–140Google Scholar
  59. 59.
    Van Balen HGG, Mulder Th (1996) Beyond the stereotype: an epidemiological study on the long-term sequelae of traumatic brain injury. Clin Rehabil 10: 259–266CrossRefGoogle Scholar
  60. 60.
    Moore AD, Stambrook M, Gill DD, Lubusko AA (1992) Differences in long-term quality of life in married and single TBI patients. Can J Rehabil 6: 89–98Google Scholar
  61. 61.
    Fleming JH, Strong J, Ashton R (1998) Cluster analysis of self-awareness levels in adults with traumatic brain injury and relationship to outcome. J Head Trauma Rehabil 13: 39–51PubMedCrossRefGoogle Scholar
  62. 62.
    Temkin N, McLean A, Dikmen S, Gale J, Bergner M, Alines MJ (1988) Development and evaluation of modifications to the Sickness Impact Profile for head injury. J Clin Epidemiol 41: 47–57PubMedCrossRefGoogle Scholar
  63. 63.
    Wilkin D, Hallam L, Doggett MA (1992) Measures of Need and Outcome for Primary Health Care. Oxford University Press, OxfordGoogle Scholar
  64. 64.
    Keith RA (1994) Functional status and health status. Arch Phys Med Rehabil 75: 478–483PubMedCrossRefGoogle Scholar
  65. 65.
    De Bruin AF, Diederiks JPM, Witte de LP, Stevens FCJ, Philipsen H (1994) The development of a short generic version of the Sickness Impact Profile. J Clin Epidemiol 47: 407–418PubMedCrossRefGoogle Scholar
  66. 66.
    Ware JE, Sherbourne CD (1992) The MOS 36-Item Short-Form Health Survey (SF-36). I: Conceptual framework and item selection. Med Care 30: 473–483PubMedCrossRefGoogle Scholar
  67. 67.
    Brazier JE, Harper R, Jones NMB, et al (1992) Validating the SF-36 health survey questionnaire: a new outcome measure for primary care. Br Med J 305: 160–164CrossRefGoogle Scholar
  68. 68.
    Ware J, Snow KK, Kosinski M, et al (1993) SF-36 Health Survey: Manual and Interpretation Guide. The Health Institute, New England Medical Center Hospitals, BostonGoogle Scholar
  69. 69.
    McHorney CA, Ware JE, Raczek AE (1993) The MOS-36-Item Short-Form Health Survey (SF-36). II: Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 31: 247–263PubMedCrossRefGoogle Scholar
  70. 70.
    Hanestad BR (1997) The MOS SF-36/RAND 36-Item Health Survey 1.0/HSQ. In: Hutchinson A, Bentzen N, König-Zahn C (eds) Cross Cultural Health Outcome Assessment: a User’s guide. European Research Group on Health Outcomes, pp 60–67Google Scholar
  71. 71.
    Coughlan AK, Storey P (1988) The Wimbledon Self-Report Scale: emotional and mood appraisal. Clin Rehabil 2: 207–213CrossRefGoogle Scholar
  72. 72.
    Nelson E, Wasson J, Kirk J, et al (1987) Assessment of function in routine clinical practice: description of the COOP Chart method and preliminary findings. J Chronic Dis 40 (suppl 1): 55S - 63SPubMedCrossRefGoogle Scholar
  73. 73.
    Scholten JHG, Van Weel C (1992) Functional Status Assessment in Family Practice: the Dartmouth COOP Functional Health Assessment Charts/WONCA. Meditekst, LelystadGoogle Scholar
  74. 74.
    Weel C van, König-Zahn C, Touw-Otten FWMM, et al (1995) Measuring Functional Health Status with the COOP/WONCA Charts. A Manual. NCH series 7 Northern Centre of Health Care Research, GroningenGoogle Scholar
  75. 75.
    Nelson EC, Landgraf JM, Hayes RD, et al (1990) The functional status of patients: how can it be measured in physician’s offices? Med Care 28: 1111–1126PubMedCrossRefGoogle Scholar
  76. 76.
    König-Zahn C (1997) The COOP/WONCA Charts. In: Hutchinson A, Bentzen N and König-Zahn C (eds) Cross Cultural Health Outcome Assessment: a User’s Guide. European Research Group on Health Outcomes, pp 48–53Google Scholar
  77. 77.
    Willer B, Ottenbacher KJ, Coad ML (1994) The community integration questionnaire. A comparitive examination. Am J Phys Med Rehabil 73: 103–111PubMedCrossRefGoogle Scholar
  78. 78.
    Dijkers M (1997) Measuring the long-term outcomes of traumatic brain injury: A review of the community integration questionnaire. J Head Trauma Rehabil 12: 74–91CrossRefGoogle Scholar
  79. 79.
    Hütter BO, Glisbach JM (1999) Das Aachener Lebensqualitätsinventar (ALQI) für Patienten mit Hirnschädigung: Erste Ergebnisse zu methodischen Gütekriterien. Zeitschrift für Neuropsychologie 10: 38Google Scholar
  80. 80.
    McMahon CG, Yates DW, Campbell FM, Hollis S, Woodford M (1999) Unexpected contribution of moderate traumatic brain injury to death after major trauma. J Trauma 47: 891–895PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2002

Authors and Affiliations

  • B. van Baalen
  • E. Odding
  • A. I. R. Maas

There are no affiliations available

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