A survey of physicians perceptions of disability outcomes after hypothetical traumatic brain injury

This study aimed to quantify physician perceptions of health utility states after traumatic brain injury (TBI) using the Glasgow Outcome Scale-Extended (GOSE). Conducted via a cross-sectional, web-based survey, it involved 646 board-certified physicians from specialties such as neurology, neurosurgery, surgical critical care, pulmonary critical care, and physical medicine & rehabilitation, with 528 completing all seven GOSE scenarios. The survey employed a standard gamble approach to assess health utility preferences for hypothetical outcomes one-year post-TBI, where physicians chose between living in a specific GOSE state or a gamble with a 50% chance of perfect health and a 50% chance of immediate death. Results showed that median health utility values for GOSE states ranged from - 1 (worse than death) to 1 (full health). Physicians rated lower GOSE states with diminished utility, perceiving levels 2 and 3 as worse than death, and noted a significant decline in perceived quality of life between GOSE 5 and 4, indicating increased sensitivity to greater dependence on caregivers. Physicians assigned lower health utility values to less severe disability states compared to the general population, as well as TBI caregivers and survivors reported in the literature, highlighting potential biases that could impact clinical decision-making. These findings underscore the need for targeted interventions to address physician perceptions, aiming to improve shared decision-making and patient-centered care in TBI treatment.