Page 231 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE
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The GOS/GOSE is a very usefull functional outcome measure, but does not include the essential subtleties of well-being. The use of ‘favourable’ and ‘unfavourable’ as substitutes for ‘acceptable’ and ‘unacceptable’ outcome is inadequate. These terms should not be interpreted or used as such in acute treatment decision-making.
Table 2 Explanation of Glasgow Outcome Scale (- Extended). 61
General discussion and future perspectives
  Glasgow Outcome Scale (GOS)
Glasgow Outcome Scale – Extended (GOSE)
Brief description
Death
Absence of awareness of self and environment
Needs full assistance in daily life Needs partial assistance in daily life
Independent, but cannot resume work/ school or all previous social activities Some disability exists, but can partly resume work or previous activities
Minor physical or mental deficit that affects daily life
Full recovery or minor symptoms that do not affect daily life
     2. Death
3. Vegetative state 3.
2. Death Vegetative state
  4. Severe disability 6.
7. Upper severe disability
9. Moderate disability 10.
11. Upper moderate disability
Lower severe disability
  Lower moderate disability
 8. Good recovery 12.
13. Upper good recovery
Health-Related Quality of Life (HRQoL)
Lower good recovery
    HRQoL measures focus on a patient’s view on the impact of TBI and a certain health status on their (quality of) life. They are a multi-dimensional concept including physical, mental, emotional, and social functioning. Generic HRQoL instruments are designed to investigate particular interventions or populations. 63 Disease-specific HRQoL measures have been specifically designed for a disease and are assumed to be more sensitive to that disease, allowing more precise outcome information.
The Quality of Life after Brain Injury (QOLIBRI) is an example of a TBI-specific HRQoL measure. 64 The applicability of the QOLIBRI in s-TBI patients however remains unclear. Most s-TBI patients suffer from cognitive impairment and communicative difficulties. Patients are hardly able to complete the questions, and, likely for this reasons, the QOLIBRI has only been validated in patients without substantial post-traumatic cognitive restraints. 65 Proxies are often unable to adequately substitute a patients view. 52 The QOLIBRI cut-off point of 60 (score 0 to 100) for quantifying a ‘good’ HRQoL also remains unclear and is prone for subjectivity. 66 Generic HRQoL instruments like the SF-36, EQ-5D, or WHOQOL-BREF are also considered to be less useful in patients with moderate or severe TBI (GCS 3-12). 67,68
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Favourable Unfavourable





































































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