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CC BY 4.0 · Surg J (N Y) 2021; 07(02): e100-e110
DOI: 10.1055/s-0041-1726426
Original Article

Predicting the Health-related Quality of Life in Patients Following Traumatic Brain Injury

Thara Tunthanathip
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Thakul Oearsakul
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Pimwara Tanvejsilp
2   Department of Pharmacy Administration, Faculty of Pharmaceutical Sciences, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Sakchai Sae-heng
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Anukoon Kaewborisutsakul
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Suphavadee Madteng
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
,
Srirat Inkate
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, Thailand
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Abstract

Background Traumatic brain injury (TBI) commonly causes death and disability that can result in productivity loss and economic burden. The health-related quality of life (HRQoL) has been measured in patients suffering from TBI, both in clinical and socioeconomic perspectives. The study aimed to assess the HRQoL in patients following TBI using the European quality of life measure-5 domain-5 level (EQ-5D-5L) questionnaire and develop models for predicting the EQ-5D-5L index score in patients with TBI.

Method A cross-sectional study was performed with 193 TBI patients who had completed the EQ-5D-5L questionnaire. The clinical characteristics, Glasgow coma scale (GCS) score, treatment, and Glasgow outcome scale (GOS) were collected. The total data was divided into training data (80%) and testing data (20%); hence, the factors affecting the EQ-5D-5L index scores were used to develop the predictive model with linear and nonlinear regression. The performances of the predictive models were estimated with the adjusted coefficient of determination (R2) and the root mean square error (RMSE).

Results A good recovery was found at 96.4%, while 2.1% displayed an unfavorable outcome. Moreover, the mean EQ-5D-5L index scores were 0.91558 (standard deviation [SD] 1.09639). GCS score, pupillary light reflex, surgery, and GOS score significantly correlated with the HRQoL scores. The multiple linear regression model had a high adjusted R2 of 0.6971 and a low RMSE of 0.06701, while the polynomial regression developed a nonlinear model that had the highest adjusted R2 of 0.6843 and the lowest RMSE of 0.06748.

Conclusions A strong positive correlation between the physician-based outcome as GOS and HRQoL was observed. Furthermore, both the linear and nonlinear regression models were acceptable approaches to predict the HRQoL of patients after TBI. There would be limitations for estimating the HRQoL in unconscious or intubated patients. The HRQoL obtained from the predictive models would be an alternative method to resolve this problem.

Keywords

traumatic brain injury - heath-related quality of life - EQ-5D-5L

Financial Support and Sponsorship

Faculty of Medicine, Prince of Songkla University, HatYai, Songkhla, 90110, Thailand. (REC.61–116–10–1)


Declarations

All procedures performed in the study that involved studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee or both and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards (REC.61–116–10–1).


Author Contributions

TT and TO conceived the study and designed the method. TT, SS, SM, and SI supervised the conduct of the data collection. TT and TO undertook the recruitment of participating centers and patients and managed the data, including quality control. TT, PT provided statistical advice on the study design and analyzed the data. TT and TO drafted the manuscript, and all authors contributed substantially to its revision. TT takes responsibility for the paper as a whole.


Supplementary Material



Publication History

Received: 06 September 2020

Accepted: 12 November 2020

Article published online:
17 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 The Centers for Disease Control and Prevention. CDC newsroom. Accessed December 1, 2020 at: https://www.cdc.gov/media/releases/2018/p0904-tbi-guidelines.html
    PubMedGoogle Scholar
  • 2 The Lancet. The burden of traumatic brain injury in children. Lancet 2018; 391 (10123): 813
    CrossrefPubMedGoogle Scholar
  • 3 Suskauer SJ, Houtrow AJ. Invited commentary on “The Report to Congress on the Management of Traumatic Brain Injury in Children”. Arch Phys Med Rehabil 2018; 99 (11) 2389-2391
    CrossrefPubMedGoogle Scholar
  • 4 Lumba-Brown A, Yeates KO, Sarmiento K. et al. Centers for disease control and prevention guideline on the diagnosis and management of mild traumatic brain injury among children. JAMA Pediatr 2018; 172 (11) e182853
    CrossrefPubMedGoogle Scholar
  • 5 ThaiRoads Foundation and Thailand Accident Research Center (TARC), Asian Institute of Technology. Key facts on road safety situations in Thailand 2012–2013. Accessed December 1, 2020 at: http://www.roadsafetythai.org/edoc/doc_20181208173742.pdf
    PubMedGoogle Scholar
  • 6 Tunthanathip T, Phuenpathom N. Impact of Road Traffic Injury to Pediatric Traumatic Brain Injury in Southern Thailand. J Neurosci Rural Pract 2017; 8 (04) 601-608
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Chaitanya K, Addanki A, Karambelkar R, Ranjan R. Traumatic brain injury in Indian children. Childs Nerv Syst 2018; 34 (06) 1119-1123
    CrossrefPubMedGoogle Scholar
  • 8 Fulkerson DH, White IK, Rees JM. et al. Analysis of long-term (median 10.5 years) outcomes in children presenting with traumatic brain injury and an initial Glasgow Coma Scale score of 3 or 4. J Neurosurg Pediatr 2015; 16 (04) 410-419
    CrossrefPubMedGoogle Scholar
  • 9 The Centers for Disease Control and Prevention. Traumatic Brain Injury & Concussion: Severe TBI. Accessed December 1, 2020 at: https://www.cdc.gov/traumaticbraininjury/severe.html
    PubMedGoogle Scholar
  • 10 Kavosi Z, Jafari A, Hatam N, Enaami M. The economic burden of traumatic brain injury due to fatal traffic accidents in shahid rajaei trauma hospital, shiraz, iran. Arch Trauma Res 2015; 4 (01) e22594
    CrossrefPubMedGoogle Scholar
  • 11 National Institute for Health and Care Excellence. Guide to the Methods of Technology Appraisal 2013. Accessed December 1, 2020 at: https://www.nice.org.uk/process/pmg9/chapter/foreword
    PubMedGoogle Scholar
  • 12 Dijkers MP. Quality of life after traumatic brain injury: a review of research approaches and findings. Arch Phys Med Rehabil 2004; 85 (04, Suppl 2): S21-S35
    PubMedGoogle Scholar
  • 13 World Health Organization. WHOQOL: Measuring Quality of Life. Accessed December 1, 2020 at: https://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/
    PubMedGoogle Scholar
  • 14 von Steinbuechel N, Covic A, Polinder S. et al. Assessment of Health-Related Quality of Life after TBI: Comparison of a Disease-Specific (QOLIBRI) with a Generic (SF-36) Instrument. Behav Neurol 2016; 2016: 7928014
    CrossrefPubMedGoogle Scholar
  • 15 Born K, Amsler F, Gross T. Prospective evaluation of the Quality of Life after Brain Injury (QOLIBRI) score: minor differences in patients with major versus no or mild traumatic brain injury at one-year follow up. Health Qual Life Outcomes 2018; 16 (01) 136
    CrossrefPubMedGoogle Scholar
  • 16 Carlozzi NE, Kallen MA, Hanks R. et al. The TBI-CareQOL Measurement System: Development and Preliminary Validation of Health-Related Quality of Life Measures for Caregivers of Civilians and Service Members/Veterans With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 100 (4S): S1-S12
    CrossrefPubMedGoogle Scholar
  • 17 Steadman-Pare D, Colantonio A, Ratcliff G, Chase S, Vernich L. Factors associated with perceived quality of life many years after traumatic brain injury. J Head Trauma Rehabil 2001; 16 (04) 330-342
    CrossrefPubMedGoogle Scholar
  • 18 Johnson JA, Luo N, Shaw JW, Kind P, Coons SJ. Valuations of EQ-5D health states: are the United States and United Kingdom different?. Med Care 2005; 43 (03) 221-228
    CrossrefPubMedGoogle Scholar
  • 19 Yang Z, Busschbach J, Liu G, Luo N. EQ-5D-5L norms for the urban Chinese population in China. Health Qual Life Outcomes 2018; 16 (01) 210
    CrossrefPubMedGoogle Scholar
  • 20 Golicki D, Niewada M. EQ-5D-5L Polish population norms. Arch Med Sci 2017; 13 (01) 191-200
    CrossrefPubMedGoogle Scholar
  • 21 Jakola AS, Unsgård G, Solheim O. Quality of life in patients with intracranial gliomas: the impact of modern image-guided surgery. J Neurosurg 2011; 114 (Suppl. 06) 1622-1630
    PubMedGoogle Scholar
  • 22 Jansson KA, Németh G, Granath F, Jönsson B, Blomqvist P. Health-related quality of life (EQ-5D) before and one year after surgery for lumbar spinal stenosis. J Bone Joint Surg Br 2009; 91 (02) 210-216
    CrossrefPubMedGoogle Scholar
  • 23 Tajima R, Kondo M, Kai H. et al. Measurement of health-related quality of life in patients with chronic kidney disease in Japan with EuroQol (EQ-5D). Clin Exp Nephrol 2010; 14 (04) 340-348
    CrossrefPubMedGoogle Scholar
  • 24 Parik PC, Patel VJ. Health-related quality of life of patients with type 2 diabetes mellitus at a tertiary care hospital in India using EQ 5D 5L. Indian J Endocrinol Metab 2019; 23 (04) 407-411
    CrossrefPubMedGoogle Scholar
  • 25 Voormolen DC, Cnossen MC, Polinder S. et al. Prevalence of post-concussion-like symptoms in the general population in Italy, The Netherlands and the United Kingdom. Brain Inj 2019; 33 (08) 1078-1086
    CrossrefPubMedGoogle Scholar
  • 26 Ward Fuller G, Hernandez M, Pallot D, Lecky F, Stevenson M, Gabbe B. Health state preference weights for the Glasgow outcome scale following traumatic brain injury: a systematic review and mapping study. Value Health 2017; 20 (01) 141-151
    CrossrefPubMedGoogle Scholar
  • 27 EuroQol Research Foundation. EQ-5D–5L. Accessed December 1, 2020 at: https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/
    PubMedGoogle Scholar
  • 28 Pattanaphesaj J. Health-related quality of life measure (EQ-5D–5L): measurement property testing and its preference-based score in Thai population [doctoral dissertation]. Mahidol University. 2014
    Google Scholar
  • 29 Perry III EC, Ahmed HM, Origitano TC. Neurotraumatology. Handb Clin Neurol 2014; 121: 1751-1772
    CrossrefPubMedGoogle Scholar
  • 30 Maas AI, Marmarou A, Murray GD, Teasdale SG, Steyerberg EW. Prognosis and clinical trial design in traumatic brain injury: the IMPACT study. J Neurotrauma 2007; 24 (02) 232-238
    CrossrefPubMedGoogle Scholar
  • 31 Edwards P, Arango M, Balica L. et al; CRASH trial collaborators. Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury-outcomes at 6 months. Lancet 2005; 365 (9475): 1957-1959
    CrossrefPubMedGoogle Scholar
  • 32 Pattanaphesaj J, Thavorncharoensap M, Ramos-Goñi JM, Tongsiri S, Ingsrisawang L, Teerawattananon Y. The EQ-5D-5L valuation study in Thailand. Expert Rev Pharmacoecon Outcomes Res 2018; 18 (05) 551-558
    CrossrefPubMedGoogle Scholar
  • 33 Kim JH. Multicollinearity and misleading statistical results. Korean J Anesthesiol 2019; 72 (06) 558-569
    CrossrefPubMedGoogle Scholar
  • 34 Yoo W, Mayberry R, Bae S. et al; A study of effects of multicollinearity in the multivariable analysis. Int J Appl Sci Technol 2014; 4(5): 9-19
    PubMedGoogle Scholar
  • 35 Jiang JY, Gao GY, Li WP, Yu MK, Zhu C. Early indicators of prognosis in 846 cases of severe traumatic brain injury. J Neurotrauma 2002; 19 (07) 869-874
    CrossrefPubMedGoogle Scholar
  • 36 Perel P, Arango M, Clayton T. et al; MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ 2008; 336 (7641): 425-429
    CrossrefPubMedGoogle Scholar
  • 37 Owolabi MO. Health-related quality of life (HRQOL) measures: there are still many unanswered questions about human life. ScientificWorldJournal 2008; 8: 357-363
    CrossrefPubMedGoogle Scholar
  • 38 Kosty J, Macyszyn L, Lai K, McCroskery J, Park HR, Stein SC. Relating quality of life to Glasgow outcome scale health states. J Neurotrauma 2012; 29 (07) 1322-1327
    CrossrefPubMedGoogle Scholar
  • 39 Tsauo JY, Hwang JS, Chiu WT, Hung CC, Wang JD. Estimation of expected utility gained from the helmet law in Taiwan by quality-adjusted survival time. Accid Anal Prev 1999; 31 (03) 253-263
    CrossrefPubMedGoogle Scholar
  • 40 Balestreri M, Czosnyka M, Chatfield DA. et al. Predictive value of Glasgow Coma Scale after brain trauma: change in trend over the past ten years. J Neurol Neurosurg Psychiatry 2004; 75 (01) 161-162
    PubMedGoogle Scholar
  • 41 Kodliwadmath HB, Koppad SN, Desai M. et al. Correlation of Glasgow Outcome Score to Glasgow Coma Score Assessed at Admission. Accessed December 1, 2020 at: https://www.ijsurgery.com/index.php/isj/article/view/131
    PubMedGoogle Scholar
  • 42 Verdugo MA, Fernández M, Gómez LE, Amor AM, Aza A. Predictive factors of quality of life in acquired brain injury. Int J Clin Health Psychol 2019; 19 (03) 189-197
    CrossrefPubMedGoogle Scholar
  • 43 Weber KT, Guimarães VA, Pontes Neto OM, Leite JP, Takayanagui OM, Santos-Pontelli TE. Predictors of quality of life after moderate to severe traumatic brain injury. Arq Neuropsiquiatr 2016; 74 (05) 409-415
    Article in Thieme ConnectPubMedGoogle Scholar
  • 44 Yuan F, Ding J, Chen H. et al. Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics. J Trauma Acute Care Surg 2012; 73 (01) 137-145
    CrossrefPubMedGoogle Scholar
  • 45 Tunthanathip T, Sae-Heng S, Oearsakul T. et al. Machine learning applications for the prediction of surgical site infection in neurological operations. Neurosurg Focus 2019; 47 (02) E7
    CrossrefPubMedGoogle Scholar
  • 46 Tunthanathip T, Sangkhathat S. Temozolomide for patients with wild-type isocitrate dehydrogenase (IDH) 1 glioblastoma using propensity score matching. Clin Neurol Neurosurg 2020; 191: 105712
    CrossrefPubMedGoogle Scholar
  • 47 Maas AI, Stocchetti N, Bullock R. Moderate and severe traumatic brain injury in adults. Lancet Neurol 2008; 7 (08) 728-741
    CrossrefPubMedGoogle Scholar
  • 48 Mayo clinic. Post-concussion syndrome. Accessed December 1, 2020 at: https://www.mayoclinic.org/diseases-conditions/post-concussion-syndrome/symptoms-causes/syc-20353352
    PubMedGoogle Scholar
  • 49 Karzmark P, Hall K, Englander J. Late-onset post-concussion symptoms after mild brain injury: the role of premorbid, injury-related, environmental, and personality factors. Brain Inj 1995; 9 (01) 21-26
    CrossrefPubMedGoogle Scholar