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
› Author Affiliations


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.

Financial Support and Sponsorship

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


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. (

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