• Amelia W Maiga, Madison R Cook, Mina F Nordness, Yue Gao, Shayan Rakhit, Erika L Rivera, Frank E Harrell, and Mayur B Patel.
• Department of Surgery, Division of Acute Care Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN.
• Ann. Surg. 2024 Jul 1; 280 (1): 144149144-149.

ObjectiveTo quantify health utilities of the Glasgow Outcome Scale-Extended (GOSE) states after actual traumatic brain injury (TBI).BackgroundRecovery after TBI is measured using the GOSE, a validated clinical trial endpoint. A recent public survey quantified the health utilities of some GOSE states after hypothetical TBI as worse than death. However, no health utilities exist for disability after actual TBI.MethodsThis national computer-adaptive survey followed Enhancing the Quality and Transparency of Health Research-Checklist for Reporting Results of Internet E-Surveys guidelines and recruited adult TBI survivors (injury >1 year prior) through their available surrogates. Using a standard gamble approach in randomized order, participants gave preferences for post-TBI categorical health states ranging from GOSE 2 to GOSE 8. We calculated median (interquartile range) health utilities for each GOSE state, from -1 (worse than death) to 1 (full health), with 0 as reference (death, GOSE 1).ResultsOf 515 eligible, 298 surrogates (58%) consented and completed the scenarios on TBI survivors' behalf. TBI survivors had a current median GOSE 5 (3-7). GOSE 2, GOSE 3, and GOSE 4 were rated worse than death by 89%, 64%, and 38%, respectively. The relationship was nonlinear, and intervals were unequal between states, with a bimodal distribution for GOSE 4.ConclusionsIn this index study of actual post-TBI disability, poor neurological outcomes represented by GOSE 2 to GOSE 4 were perceived as worse than death by at least one in 3 survivors. Similar to previously reported public perceptions after a hypothetical TBI, these long-term perceptions may inform earlier post-TBI shared decision-making, as well as help shape value-based research and quality of care.Level Of EvidenceLevel II-economic and value-based evaluations.Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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