Contribution of Extracranial Injuries to GOSE Scores after Traumatic Brain Injury TBI: A TRACK-Traumatic Brain Injury Study

The Glasgow Outcome Scale Extended (GOSE) is the most widely used outcome measure for hospital-based studies of traumatic brain injury (TBI). The GOSE may be administered several ways, the choice depending on the purpose of the research. In this investigation, we evaluated the effect of administering the GOSE to collect functional disability attributed to all injuries sustained (GOSE-All) or excluding the impact of extracranial injuries (GOSE-TBI). We examined the differences in reported disability between the two administration methods at 2 weeks, 3 months, 6 months, and 12 months after injury. Data are summarized from 2288 individuals who were enrolled in the prospective observational Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort study. The distribution of scores is summarized by time after injury, brain injury severity, and extracranial injury severity. Dichotomizing the GOSE varying ways, differences in the prevalence of unfavorable outcomes for GOSE-All versus GOSE-TBI range from none to 42 percentage points. Discrepancies in disability captured by GOSE-All and GOSE-TBI decrease with greater TBI severity, no serious extracranial injuries, and longer time post-injury. It is important for researchers, given the aims of their studies, to decide in advance whether GOSE classification should be based on the effects of all injuries sustained or excluding the effects of extracranial injuries so as to emphasize the effects of the brain injury, as well as how disability due to emotional consequences of injury and other circumstances will be scored. Instructions to the respondent and outcomes examiner need to be clear about what causes of disability are to be included. The TBI Common Data Elements should include information that reflects the method that was used to collect the GOSE data and data repositories should disclose which data collection method was used for a given study.