Employment outcome four years after a severe traumatic brain injury: results of the Paris severe traumatic brain injury study

Abstract

Objective: To describe employment outcome four years after a severe traumatic brain injury by the assessment of individual patients’ preinjury sociodemographic data, injury-related and postinjury factors.

Design: A prospective, multicenter inception cohort of 133 adult patients in the Paris area (France) who had received a severe traumatic brain injury were followed up postinjury at one and four years. Sociodemographic data, factors related to injury severity and one-year functional and cognitive outcomes were prospectively collected.

Methods: The main outcome measure was employment status. Potential predictors of employment status were assessed by univariate and multivariate analysis.

Results: At the four-year follow-up, 38% of patients were in paid employment. The following factors were independent predictors of unemployment: being unemployed or studying before traumatic brain injury, traumatic brain injury severity (i.e., a lower Glasgow Coma Scale score upon admission and a longer stay in intensive care) and a lower one-year Glasgow Outcome Scale–Extended score.

Conclusion: This study confirmed the low rate of long-term employment amongst patients after a severe traumatic brain injury. The results illustrated the multiple determinants of employment outcome and suggested that students who had received a traumatic brain injury were particularly likely to be unemployed, thus we propose that they may require specific support to help them find work.

Implications for rehabilitation

• Traumatic brain injury is a leading cause of persistent disablity and can associate cognitive, emotional, physical and sensory impairments, which often result in quality-of-life reduction and job loss.

• Predictors of post-traumatic brain injury unemployment and job loss remains unclear in the particular population of severe traumatic brain injury patients.

• The present study highlights the post-traumatic brain injury student population require a close follow-up and vocational rehabilitation.

• The study suggests that return to work post-severe traumatic brain injury is frequently unstable and workers often experience difficulties that caregivers have to consider.

Keywords:

• Traumatic brain injury
• follow-up study
• employment
• return to work
• disability

Acknowledgements

The authors thank all patients and family participants, and members of the CRFTC Steering Committee (Centre Ressource Francilien des Traumatisés Crâniens) for their valuable help. This study was funded by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2004), grant number AOM04084; the Institut de Recherche en Santé Publique (IRESP). It was supported by AP-HP (Département de la Recherche Clinique et du Développement).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by grants from the French Ministry of Health (Programme Hospitalier de Recherche Clinique 2004), grant number AOM04084; the Institut de Recherche en Santé Publique (IRESP). It was supported by AP-HP (Département de la Recherche Clinique et du Développement).