{
  "abstract": "Background Long-term functional and vocational outcomes after traumatic brain injury (TBI) remain difficult to predict, limiting prognostic counselling and rehabilitation planning. We aimed to evaluate the Clinical-Biomarker-Imaging-Modifier (CBI-M) framework for predicting functional and employment outcomes up to 10 years following TBI.Methods Retrospective cohort study of 2529 patients with TBI admitted for inpatient rehabilitation (1984–2024), contributing 5424 observations across 1, 2, 5 and 10 years post-injury. Prediction models used logistic regression with temporal validation, incorporating 21 CBI-M variables spanning clinical (post-traumatic amnesia (PTA), Glasgow Coma Scale (GCS)), imaging (9 CT variables) and modifier pillars (age, sex, pre-injury employment, mental health, extracranial injuries). Outcomes were Glasgow Outcome Scale-Extended (GOSE) functional outcomes (favourable outcome, return to participation, full recovery) and employment outcomes (any productive work, competitive work).Results Mean age was 38.7 years (SD=18.5); 705 (27.9%) were female. Models demonstrated good discrimination (mean area under the curve (AUC) 0.720; range 0.635–0.863), with 60% achieving AUC ≥0.70. Employment outcomes were slightly more predictable than GOSE outcomes (mean AUC 0.740 vs 0.70). PTA dominated prediction across both outcome types (GOSE: 28.8% variable importance; employment: 24%) versus GCS (GOSE: 3.9%; employment: 3.3%). Pre-injury employment was the second most important predictor for vocational outcomes (16.9%) after PTA. The clinical pillar was the dominant per-feature contributor to both GOSE (69.9%) and employment (64.5%) predictions, while the modifier pillar contributed most in absolute terms (41.6% and 50.8%, respectively).Conclusions The CBI-M framework predicts functional and vocational outcomes up to 10 years post-TBI. PTA substantially outperforms GCS for long-term prognostication in TBI survivors, and vocational outcomes also depend on pre-injury social factors.",
  "authors": [
    {
      "affiliations": [
        "School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia",
        "Department of Neuroscience, Monash University, Melbourne, Victoria, Australia",
        "Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Gershon Spitz"
    },
    {
      "affiliations": [
        "School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia",
        "Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Marina Downing"
    },
    {
      "affiliations": [
        "Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Megan Carty"
    },
    {
      "affiliations": [
        "Monash-Epworth Rehabilitation Research Centre, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Jennie L Ponsford"
    }
  ],
  "title": "Long-term prediction of traumatic brain injury outcome using the CBI-M framework",
  "uid": "41b37174-c386-50d7-8d0d-1aeb9bc45a67"
}