Page 97 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Outcome versus in-hospital costs: a neurosurgical paradox?
Score scale (GCS) categories (GCS13-15: mild, GCS 9-12: moderate, GCS 3-8: severe). 22 In addition, a subgroup of patients with a very severe TBI (vs-TBI), represented by a GCS of 3-5, was analysed. The first GCS score documented at the emergency room (ER) was used and in case of intubation and/or sedation, the last score before intubation and/or sedation was used.
Clinical & follow-up data
Data was collected independently by two authors in a predefined database using
electronic or paper patient records. It encompassed demographics, patient and trauma 4 specific information and pre and in-hospital parameters including medical/surgical interventions and length of stay. Non-ICU admission included admission on the ward
and medium care. Focal neurologic symptoms included paresis, aphasia or cranial
nerve deficit. Pupils were defined abnormal when at least one pupil was unresponsive
to light upon arrival in the emergency room. CT characteristics were assessed from
the first CT-scan. Outcome data included in-hospital mortality and Glasgow Outcome
Score (GOS) dichotomized in favourable (GOS 4-5) and unfavourable (GOS 1-3)
outcome obtained from discharge or outpatient clinic letters 3-9 months after trauma.
14 To determine the TBI-specific HRQoL, we used the postal Quality of Life after Brain
Injury (QOLIBRI) questionnaire. After receiving ethical approval to approach patients,
we obtained informed consent and asked patients to complete and return the questionnaire two to six years after trauma. Mortality at this time-point was also noted.
The QOLIBRI is a comprehensive 37-item questionnaire investigating six dimensions
that are typically affected after TBI. 15 Patients rate their (dis)satisfaction (1-5 scale) on
six subscales representing the dimensions: cognition, self, daily life & autonomy, social relationships, emotions and physical problems. Scores are transformed to total scores
ranging from 0 (worst possible quality of life) to 100 (best possible quality of life). 15 A
score lower than 60 is believed to represent a low or impaired HRQoL. 23 In case patients
did not return the questionnaire, the investigators attempted a telephone interview, or
family members were asked to assist in completing the forms. In addition, the reason
for not returning (e.g. death, persistent unresponsive state etc.) the questionnaire was
collected at this time point.
Cost data
Cost data analysis was performed from a health care provider perspective and focussed on in-hospital healthcare costs. The Dutch National Health Care Institute guidelines for healthcare cost calculation were followed. 24
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