BMJ 2000;320:1631-1635 ( 17 June )

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Disability in young people and adults one year after head injury: prospective cohort study

Sharon Thornhill, research assistant, ^a Graham M Teasdale, professor, ^a Gordon D Murray, professor of medical statistics, ^b James McEwen, professor of public health, ^c Christopher W Roy, consultant in rehabilitation medicine, ^d Kay I Penny, research fellow. ^e

^a Department of Neurosurgery, University of Glasgow, Southern General NHS Trust, Glasgow G51 4TF, ^b Department of Community Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, ^c University of Glasgow, Glasgow G12 8QQ, ^d Southern General NHS Trust, Glasgow G51 4TF, ^e Department of Community Health Sciences, University of Edinburgh

Correspondence to: G M Teasdale y.mitchell{at}clinmed.gla.ac.uk

Objective: To determine the frequency of disability in young people and adults admitted to hospital with a head injury and to estimate the annual incidence in the community.
Design: Prospective, hospital based cohort study, with one year follow up of sample stratified by coma score.
Setting: Five acute hospitals in Glasgow.
Subjects: 2962 patients (aged 14 years or more) with head injury; 549 (71%) of the 769 patients selected for follow up participated.
Main outcome measures: Glasgow outcome scale and problem orientated questionnaire.
Results: Survival with moderate or severe disability was common after mild head injury (47%, 95% confidence interval 42% to 52%) and similar to that after moderate (45%, 35% to 56%) or severe injury (48%, 36% to 60%). By extrapolation from the population identified (90% of whom had mild injuries), it was estimated that annually in Glasgow (population 909 498) 1400 young people and adults are still disabled one year after head injury.
Conclusion: The incidence of disability in young people and adults admitted with a head injury is higher than expected. This reflects the high rate of sequelae previously unrecognised in the large number of patients admitted to hospital with an apparently mild head injury.

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