Disability in young people and adults one year after head injury: prospective cohort study

TLDR

Mild head injury is associated with a surprisingly high rate of sequelae that has been largely unrecognised in hospital admissions. The study aimed to quantify the frequency of disability among young people and adults admitted with head injury and to estimate its annual community incidence. A prospective, hospital‑based cohort of 2,962 patients aged 14 or older was followed for one year at five Glasgow hospitals, with 549 participants completing the Glasgow Outcome Scale and a problem‑oriented questionnaire. Nearly half of patients with mild head injury (47 %) experienced moderate or severe disability at one year, a rate comparable to moderate (45 %) and severe (48 %) injuries, implying an estimated 1,400 Glasgow residents remain disabled annually, a higher incidence than expected.

Abstract

<h3>Abstract</h3> <b>Objective:</b> To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community. <b>Design:</b> Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score. <b>Setting:</b> Five acute hospitals in Glasgow. <b>Subjects:</b> 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated. <b>Main outcome measures:</b> Glasgow outcome scale and problem orientated questionnaire. <b>Results:</b> Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury. <b>Conclusion:</b> The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.