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Employment Following Traumatic Head Injuries

Employment Following Traumatic Head Injuries Abstract Objective: Determine rates of, and factors predictive of, return to work in patients with civilian traumatic head injuries. Design: Inception cohort study with 1- to 2-year follow-up. Setting: Hospitalized patients in a level I trauma center. Patients: Three hundred sixty-six hospitalized head-injured subjects who were workers before injury and 95 comparison subjects participated in prospective, longitudinal investigations of employment following head injury. Head-injured and comparison subjects were similar on basic demographics and preinjury employment status. The comparison subjects consisted of patients who sustained traumatic injury to the body but not to the head. Main Outcome Measure: Time taken to return to work following head injury. Results: Survival methodology was used for analysis. Whether patients returned to work and when related to both the characteristics of the injured patients (eg, education, preinjury work history), the severity of head injury and associated neuropsychologic problems, and severity of other system injuries. More precise predictions were possible using the multivariate model. Conclusions: The present study provides a means of assessing employment potential predictively. This can be useful for clinical and research purposes. The results should be used cautiously and should stimulate discussions of appropriate use of services and resources to meet individual patients' needs. References 1. Fraser R, Dikmen S, McLean A, Miller B, Temkin N. Employability of head injury survivors: first year post-injury . Rehab Counsel Bull . 1988;31:276-288. 2. MacKenzie EJ, Shapiro S, Smith RT, Siegel JH, Moody M, Pitt A. Factors influencing return to work following hospitalization for traumatic injury . Am J Public Health . 1987;77:329-334.Crossref 3. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma . Neurosurgery . 1982;11:344-351.Crossref 4. Oddy M, Humphrey M. Social recovery during the year following severe head injury . J Neurol Neurosurg Psychiatry . 1980;43:798-802.Crossref 5. Brooks N, McKinlay W, Symington C, Beattie A, Campsie L. Return to work within the first seven years of severe head injury . Brain Inj . 1987;1:5-19.Crossref 6. Dacey R, Dikmen S, Temkin N, McLean A, Armsden G, Winn HR. Relative effects of brain and non-brain injuries on neuropsychological and psychosocial outcome . J Trauma . 1991;31:217-222.Crossref 7. Dikmen S, McLean A, Temkin N. Neuropsychological and psychosocial consequences of minor head injury . J Neurol Neurosurg Psychiatry . 1986;49: 1227-1232.Crossref 8. Heiskanen O, Sipponen P. Prognosis of severe brain injury . Acta Neurol Scand . 1970;46:343-348.Crossref 9. Bruckner FE, Randle APH. Return to work after severe head injuries . Rheumatol Phys Med . 1972;11:344-347.Crossref 10. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury . Neurosurgery . 1981;9:221-228.Crossref 11. Dresser AC, Meirowsky AM, Weiss GH, McNeel ML, Simon GA, Caveness WF. Gainful employment following head injury . Arch Neurol . 1973;29:111-116.Crossref 12. Dikmen S, Temkin N, Miller B, Machamer J, Winn HR. Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures . JAMA . 1991;265:1271-1277.Crossref 13. Kay T, Ezrachi O, Cavallo M. Annotated Bibliography of Research on Vocational Outcome . New York, NY: New York University Medical Center, Research and Training Center on Head Trauma and Stroke; 1984. Publication No. 185-1. 14. Dikmen S, McLean A, Temkin N, Wyler AR. Neuropsychologic outcome at one-month postinjury . Arch Phys Med Rehabil . 1986;67:507-513. 15. Dikmen S, Temkin N, McLean A, Wyler A, Machamer J. Memory and head injury severity . J Neurol Neurosurg Psychiatry . 1987;50:1613-1618.Crossref 16. Temkin N, Dikmen S, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures . N Engl J Med . 1990;323:497-502.Crossref 17. US Department of Labor, Employment and Training Administration. Dictionary of Occupational Titles . Washington, DC: US Government Printing Office; 1977. 18. Teasdale G, Jennett B. Assessment of coma and impaired consciousness . Lancet . 1974;2:81-84.Crossref 19. Petrucelli E, States JD, Hames LN. The Abbreviated Injury Scale: evolution, usage and future adaptability . Accid Anal Prev . 1981;13:29-35.Crossref 20. Baker SP, O'Neill B, Haddon W, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma . 1974;14:187-196.Crossref 21. Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation . Tucson, Ariz: Neuropsychology Press; 1985. 22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . JAm Stat Assoc . 1958;53:457-481.Crossref 23. Cox DR. Regression models and life-tables . J R Stat Soc (B) . 1972;34:187-202. 24. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons; 1980. 25. Wehman P, McMahon BT, Fraser RT. Traumatic Brain Injury Vocational Rehabilitation: Job Placement Models . Orlando, Fla: Paul M. Deutsch Press Inc; 1991. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

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References (28)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1994.00540140087018
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: Determine rates of, and factors predictive of, return to work in patients with civilian traumatic head injuries. Design: Inception cohort study with 1- to 2-year follow-up. Setting: Hospitalized patients in a level I trauma center. Patients: Three hundred sixty-six hospitalized head-injured subjects who were workers before injury and 95 comparison subjects participated in prospective, longitudinal investigations of employment following head injury. Head-injured and comparison subjects were similar on basic demographics and preinjury employment status. The comparison subjects consisted of patients who sustained traumatic injury to the body but not to the head. Main Outcome Measure: Time taken to return to work following head injury. Results: Survival methodology was used for analysis. Whether patients returned to work and when related to both the characteristics of the injured patients (eg, education, preinjury work history), the severity of head injury and associated neuropsychologic problems, and severity of other system injuries. More precise predictions were possible using the multivariate model. Conclusions: The present study provides a means of assessing employment potential predictively. This can be useful for clinical and research purposes. The results should be used cautiously and should stimulate discussions of appropriate use of services and resources to meet individual patients' needs. References 1. Fraser R, Dikmen S, McLean A, Miller B, Temkin N. Employability of head injury survivors: first year post-injury . Rehab Counsel Bull . 1988;31:276-288. 2. MacKenzie EJ, Shapiro S, Smith RT, Siegel JH, Moody M, Pitt A. Factors influencing return to work following hospitalization for traumatic injury . Am J Public Health . 1987;77:329-334.Crossref 3. Rimel RW, Giordani B, Barth JT, Jane JA. Moderate head injury: completing the clinical spectrum of brain trauma . Neurosurgery . 1982;11:344-351.Crossref 4. Oddy M, Humphrey M. Social recovery during the year following severe head injury . J Neurol Neurosurg Psychiatry . 1980;43:798-802.Crossref 5. Brooks N, McKinlay W, Symington C, Beattie A, Campsie L. Return to work within the first seven years of severe head injury . Brain Inj . 1987;1:5-19.Crossref 6. Dacey R, Dikmen S, Temkin N, McLean A, Armsden G, Winn HR. Relative effects of brain and non-brain injuries on neuropsychological and psychosocial outcome . J Trauma . 1991;31:217-222.Crossref 7. Dikmen S, McLean A, Temkin N. Neuropsychological and psychosocial consequences of minor head injury . J Neurol Neurosurg Psychiatry . 1986;49: 1227-1232.Crossref 8. Heiskanen O, Sipponen P. Prognosis of severe brain injury . Acta Neurol Scand . 1970;46:343-348.Crossref 9. Bruckner FE, Randle APH. Return to work after severe head injuries . Rheumatol Phys Med . 1972;11:344-347.Crossref 10. Rimel RW, Giordani B, Barth JT, Boll TJ, Jane JA. Disability caused by minor head injury . Neurosurgery . 1981;9:221-228.Crossref 11. Dresser AC, Meirowsky AM, Weiss GH, McNeel ML, Simon GA, Caveness WF. Gainful employment following head injury . Arch Neurol . 1973;29:111-116.Crossref 12. Dikmen S, Temkin N, Miller B, Machamer J, Winn HR. Neurobehavioral effects of phenytoin prophylaxis of posttraumatic seizures . JAMA . 1991;265:1271-1277.Crossref 13. Kay T, Ezrachi O, Cavallo M. Annotated Bibliography of Research on Vocational Outcome . New York, NY: New York University Medical Center, Research and Training Center on Head Trauma and Stroke; 1984. Publication No. 185-1. 14. Dikmen S, McLean A, Temkin N, Wyler AR. Neuropsychologic outcome at one-month postinjury . Arch Phys Med Rehabil . 1986;67:507-513. 15. Dikmen S, Temkin N, McLean A, Wyler A, Machamer J. Memory and head injury severity . J Neurol Neurosurg Psychiatry . 1987;50:1613-1618.Crossref 16. Temkin N, Dikmen S, Wilensky AJ, Keihm J, Chabal S, Winn HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures . N Engl J Med . 1990;323:497-502.Crossref 17. US Department of Labor, Employment and Training Administration. Dictionary of Occupational Titles . Washington, DC: US Government Printing Office; 1977. 18. Teasdale G, Jennett B. Assessment of coma and impaired consciousness . Lancet . 1974;2:81-84.Crossref 19. Petrucelli E, States JD, Hames LN. The Abbreviated Injury Scale: evolution, usage and future adaptability . Accid Anal Prev . 1981;13:29-35.Crossref 20. Baker SP, O'Neill B, Haddon W, Long WB. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care . J Trauma . 1974;14:187-196.Crossref 21. Reitan RM, Wolfson D. The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation . Tucson, Ariz: Neuropsychology Press; 1985. 22. Kaplan EL, Meier P. Nonparametric estimation from incomplete observations . JAm Stat Assoc . 1958;53:457-481.Crossref 23. Cox DR. Regression models and life-tables . J R Stat Soc (B) . 1972;34:187-202. 24. Kalbfleisch JD, Prentice RL. The Statistical Analysis of Failure Time Data . New York, NY: John Wiley & Sons; 1980. 25. Wehman P, McMahon BT, Fraser RT. Traumatic Brain Injury Vocational Rehabilitation: Job Placement Models . Orlando, Fla: Paul M. Deutsch Press Inc; 1991.

Journal

Archives of NeurologyAmerican Medical Association

Published: Feb 1, 1994

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