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Recovery of Consciousness and Functional Outcome in Moderate and Severe Traumatic Brain Injury

By Currents Editor posted 03-22-2021 09:02


JAMA Neurology (03/01/21) DOI: 10.1001/jamaneurol.2021.0084

Kowalski, Robert G.; Hammond, Flora M.; Weintraub, Alan H.; et al.

Most patients who became comatose after moderate or severe traumatic brain injury (TBI) recovered consciousness during rehabilitation — and nearly half regained functional independence, according to new research. The cohort study involved 17,470 patients with TBI who were enrolled in the Traumatic Brain Injury Model Systems National Database. The patients had experienced moderate or severe TBI and were discharged from acute hospitalization and admitted to inpatient rehabilitation between 1989 and 2019. Overall, 57% (7,547) of the patients experienced initial loss of consciousness, with 12% (2,058) still in this state at time of admission to rehabilitation. Compared with patients without a disorder of consciousness (DOC), those with persisting DOC tended to be younger; have more high-velocity injuries; had intracranial mass effect, intraventricular hemorrhage, and subcortical contusion; and had longer acute care. During inpatient rehabilitation, 82% (1,674) of the comatose patients recovered consciousness. Factors associated with consciousness recovery were absence of intraventricular hemorrhage and intracranial mass effect. Functional improvement from admission to discharge was +43 for patients with DOC and +37 for patients without DOC, while 40% of patients with DOC became either partially or fully independent. "This recovery trajectory may inform acute and rehabilitation treatment decisions," the researchers conclude, recommending caution when considering decisions to withdraw or withhold care in patients with TBI and DOC.


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