Global Outcomes Across 20 Years After Inpatient Rehabilitation for Traumatic Brain Injury

Objective: To explore and visually display differences in the distribution of the Glasgow Outcome Scale – Extended (GOS-E) over time after traumatic brain injury (TBI), focusing on variations in outcome distributions based on GOS-E at Year 1 postinjury and age at injury. Setting: Community. Participants: 14 010 individuals who received inpatient rehabilitation in the TBI Model Systems. Design: Cross-sectional analysis of a prospectively collected longitudinal database. Main Measures: GOS-E scores at 1, 2, 5, 10, 15, and 20 years postinjury, and age at injury. Results: The proportions of cases in each GOS-E category are displayed using 100% stacked bar graphs for each follow-up period. These graphs reveal that GOS-E at Year 1 and age at injury clearly influence outcomes over time. Trends include decreasing good recovery and increasing severe disability as Year 1 GOS-E worsens, along with rising mortality rates as age at injury increases. Conclusion: The study introduces a novel approach for visually representing patterns of change in GOS-E outcomes, emphasizing differences across strata defined by GOS-E at Year 1 and age at injury. The figures provide a valuable tool for communicating potential outcomes, particularly when GOS-E at Year 1 and age are known. Evaluating the visual interpretability of these graphs among persons with brain injury, family members, healthcare providers, and other stakeholders will help determine their broader usability and value.