A Prospective Study on Employment Outcome 3 Years After Moderate to Severe Traumatic Brain Injury

Abstract Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury. Objectives To evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury. Design Prospective cohort study. Setting Patients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands. Participants Patients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI. Interventions Not applicable. Main Outcome Measures The main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM). Results Ninety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P