Repository logo
 

Study Design Features Associated with Patient Attrition in Studies of Traumatic Brain Injury: A Systematic Review.

Accepted version
Peer-reviewed

No Thumbnail Available

Type

Article

Change log

Authors

Stevenson, Susan 
Newman, Tom 
Wilson, Lindsay 
Maas, Andrew IR 

Abstract

Loss to follow-up or patient attrition is common in longitudinal studies of traumatic brain injury (TBI). Lack of understanding exists between the relation of study design and patient attrition. This review aimed to identify features of study design that are associated with attrition. We extended the analysis of a previous systematic review on missing data in 195 TBI studies using the Glasgow Outcome Scale Extended (GOSE) as an outcome measure. Studies that did not report attrition or had heterogeneous methodology were excluded, leaving 148 studies. Logistic regression found seven of the 14 design features studied to be associated with patient attrition. Four features were associated with an increase in attrition: greater follow-up frequency (odds ratio [OR]: 1.2, 95% confidence interval [CI]: 1.0-1.3), single rather than multi-center design (OR: 1.6, 95% CI: 1.2-2.2), enrollment of exclusively mild TBI patients (OR: 2.8, 95% CI: 1.6-4.9), and collection of the GOS by post or telephone without face-to-face contact (OR: 1.6, 95% CI:1.1-2.4). Conversely, two features were associated with a reduction in attrition: recruitment in an acute care setting defined as the ward or intensive care unit (OR: 0.58, 95% CI: 0.47-0.72) and a greater duration of time between injury and follow-up (OR: 0.93, 95% CI: 0.88-0.99). This review highlights design features that are associated with attrition and could be considered when planning for patient retention. Further work is needed to establish the mechanisms between the observed associations and potential remedies.

Description

Keywords

attrition, loss to follow-up, missing data, study design, traumatic brain injury, Brain Injuries, Traumatic, Glasgow Coma Scale, Glasgow Outcome Scale, Humans, Longitudinal Studies, Observational Studies as Topic, Outcome Assessment, Health Care, Patient Dropouts, Patient Selection, Research Design

Journal Title

J Neurotrauma

Conference Name

Journal ISSN

0897-7151
1557-9042

Volume Title

37

Publisher

Mary Ann Liebert Inc

Rights

All rights reserved
Sponsorship
Academy of Medical Sciences (unknown)
European Commission (602150)
The work of HFL, AIRM, DN, EWS, DKM and LW was supported in the context of CENTER-TBI (www.center-tbi.eu) by the Fp7 program of the EU (602150). VFJN was supported by an Academy of Medical Sciences / The Health Foundation Clinician Scientist Fellowship. SR was supported by a Wellcome Trust PhD Fellowship. The research was supported by the NIHR Biomedical Research Center based as the Cambridge University Hospitals NHS Foundation Trust and University of Cambridge. The views expressed are those of the authors and no necessarily those of any acknowledge funding agencies.