Outcome assessment after traumatic brain injury - Authors' reply

Abstract

First paragraph: We thank Thomas McMillan and colleagues for their thoughtful comments on assessment of outcomes, with many of which we fully agree. As with many outcome assessments in traumatic brain injury (TBI), the Glasgow Outcome Scale (GOS) is open to a wide variety of influences other than brain injury: factors related to acute TBI appear to explain at best 35% of the variance.1 The predictors, moderators, and mediators of outcome after TBI are incompletely understood. There is thus much progress to be made in identifying confounding covariates for the effects of interventions. The current approach has many strengths, as pointed out by McMillan and colleagues. However, the GOS as originally proposed was quickly recognised to have limitations, and consequently has been adapted and improved over the years. The Extended Glasgow Outcome Scale (GOSE) structured interview was originally intended to help standardise assessment of outcomes, but there is still work to be done.