McCrea M, et al. JAMA Neurol. 2021;doi:0.1001/jamaneurol.2021.2043.
McCrea reports receiving grants from the NIH, Department of Defense, CDC, National Collegiate Athletics Association, and the National Football League. Please see the study for all other authors’ relevant financial disclosures.
In a recent study, half of those with severe traumatic brain injury and three-quarters of those with moderate TBI recovered the ability to function independently at home for at least 8 hours a day.
The findings suggest that the presence of acute severe impairment does not “universally portent poor function outcomes” after moderate to severe TBI (msTBI), researchers said.
“Capturing the full longitudinal trajectory of outcomes after msTBI is critical to identifying both short-term and long-term variables that differentiate patients who will go on to favorable recovery from those at highest risk of poor long-term outcomes,” Michael McCrea, PhD, professor and director of the Brain Injury Research Program at the Medical College of Wisconsin, and colleagues wrote. “This, in turn, informs interventions to reduce overall disability associated with msTBI.”
McCrea and colleagues performed a cohort study — a part of the TRACK-TBI study — at 18 level 1 trauma centers in the United States from February 2014 to August 2018 and identified 2,679 patients with mild, moderate or severe TBI. They evaluated longitudinal outcomes, with up to 12 months post-injury follow-up. Of these patients, investigators included 484 patients with msTBI (Glasgow Coma Scale scores 3–12) in their analysis between October 2019 to April 2021.
McCrea and colleagues evaluated global functional status using the Glasgow Outcome Scale–Extended (GOSE) and Disability Rating Scale (DRS) at 2 weeks and 3, 6 and 12 months after injury. Researchers used GOSE scores to determine favorable and unfavorable outcomes. They assessed neurocognitive testing and patient-reported outcomes at 12 months.
McCrea and colleagues observed favorable outcomes in 36 of 290 patients with severe TBI (12.4%) and 38 of 93 patients with moderate TBI (41%) at 2 weeks after injury. They also saw moderate disability or worse on the DRS in 301 of 322 patients in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%).
The investigators also reported favorable outcomes at 12 months after injury for 142 of 271 patients with severe TBI (52.4%) and for 54 of 72 patients with moderate TBI (75%). No disability was reported in nearly one of five patients with severe TBI and one in three with moderate TBI.
According to McCrea and colleagues, among patients in a vegetative state at 2 weeks, 62 of 79 patients (78%) regained consciousness, and by 12 months, 14 of 56 patients with available data (25%) regained orientation.
“Clinicians should be cautious about suggesting a high likelihood of permanent severe disability within the first 2 weeks postinjury,” McCrea and colleagues wrote. “Ongoing efforts by TRACK-TBI investigators are underway to identify clinical variables that improve prognostic accuracy in patients with msTBI. In the interim, early prognostic counseling and decision-making about withdrawal of life-sustaining care should acknowledge the limitations of prognostic certainty.”