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Disabil Rehabil. 2018 Sep;40(18):2200-2207. doi: 10.1080/09638288.2017.1327992. Epub 2017 May 18.

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

Author information

a Service de Médecine Physique et de Réadaptation , CHU de Caen , France.
b U1077, INSERM , Caen , France.
c Service de Médecine Physique et de Réadaptation , APHP, Hôpital Raymond Poincaré , Garches , France.
d EA 4047 HANDIReSP , Université de Versailles Saint-Quentin , France.
e Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière , Service de Médecine Physique et Réadaptation, Paris, France, Université Pierre et Marie Curie , Paris , France.
f Assistance Publique-Hôpitaux de Paris , Hôpital Ambroise Paré, Unité de Recherche Clinique (URC) , Boulogne , France.
g Centre Ressources Francilien du Traumatisme Crânien (CRFTC) , Paris , France.
h Antenne UEROS-SAMSAH 92-UGECAM IDF , Hôpital Raymond Poincaré , Garches , France.



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.


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.


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


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.


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.


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

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