Issues of loss to follow-up in a population study of traumatic brain injury (TBI) followed to 3 years post-trauma.

PRIMARY OBJECTIVE: To examine loss to follow-up (LTFU) using a population with traumatic brain injury (TBI) to include a range of severity and to follow participants to 3 years post-injury. Also investigated were cause of TBI and employment status. RESEARCH DESIGN: The research included 947 adults from a TBI population study. Data were obtained on severity, cause of TBI and employment status and participants were followed up at 1, 3, 6, 12, 24 and 36 months after injury. Chi-squared analyses were used to examine rates of loss to follow-up. MAIN OUTCOME AND RESULTS: Overall LTFU increased from 22% at 1 month post-injury to 81% at 3-year follow-up. Most participants (52%) were employed at the time of their TBI, with 39% of TBIs being motor vehicle related. Lower LTFU at 2 and 3 years post-TBI was significantly associated with severe TBI. Within the mTBI sub-group significantly higher LTFU at 1 and 6 months after injury and at 2 and 3 years post-injury was associated with TBI from assault. Those sustaining mTBI from a fall or sport-related injury showed significantly lower LTFU at the 6-month, 12-month and 2-year follow-up points. The highest LTFU was noted for unemployed participants, with retired participants showing the lowest rate.

Pre-injury estimates of subjective quality of life following traumatic brain injury.

PRIMARY OBJECTIVE: To compare the pre-injury subjective quality of life (SQOL) estimates of a representative sample of adults with TBI, using the Quality of Life Inventory (QOLI) with the measure's generic US-based norms and identify a factor structure for the instrument within the local TBI population. RESEARCH DESIGN: A population-based, cross-sectional design conducted with data collected by the Neurotrauma Register of Tasmania (2003-2005). METHODS AND PROCEDURES: As soon as possible following their emergence from post-traumatic amnesia, 470 participants provided pre-injury estimates of their SQOL using the QOLI. The distribution of this sample was compared with the measure's normative distribution. The sample was separated evenly into two groups (n = 235) for separate exploratory and confirmatory factor analyses. MAIN OUTCOMES AND RESULTS: Small differences were found between the pre-injury estimates and the QOLI's US-based normative distribution. Corrections were provided to clinical classification ranges for this population. Three factors were identified and confirmed for the QOLI in separate TBI samples. CONCLUSION: The results of this study support the use of the QOLI in measuring SQOL in TBI rehabilitation and outcomes research.

A randomized controlled trial of piroxicam in the management of acute ankle sprain in Australian Regular Army recruits. The Kapooka Ankle Sprain Study.

Three hundred sixty-four Australian Regular Army recruits with acute ankle sprains sustained during training were randomized to treatment with either piroxicam or placebo. Compared with the placebo group, subjects treated with piroxicam had less pain, were able to resume training more rapidly, were treated at lower cost, and were found to have increased exercise endurance on resumption of activity. Nausea was the only side effect reported significantly more often in the treatment group than in the placebo group (6.8% versus 0.3%). Interestingly, subjects treated with piroxicam showed some evidence of local abnormalities such as instability and reduced range of movement. We conclude that nonsteroidal antiinflammatory agents should form an integral part of the treatment of acute ankle sprains.

Costs, severity of illness and outcome in intensive care.

Severity of illness (Therapeutic Index Severity Score, Classes 1-4) and direct clinical costs (labour costs, diagnostic costs, drugs, disposables, etc.) were determined for 100 consecutive patients admitted to Royal Newcastle Hospital Intensive Care Unit over six weeks. Outcome was assessed using mortality, quality of life, functional status, productivity and mental status one month after separation from the Unit. The mean total admission cost was $1,357 (Class 4 mean = $3,706) but for over 70% of patients costs were less than $1,000. The main component of cost was labour (about 60% for all classes). TISS proved a strong predictor (P less than 0.001) of total admission costs. Survival to one month was 89% and optimal association between cost and survival was found with those with low costs more likely to survive (P less than 0.001). On the other hand, no association was found between total admission cost and resulting quality of life. However, there was an association between pre-admission and follow-up quality of life (P less than 0.0005).