Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study
JAMA Neurology (07/06/21) DOI: 10.1001/jamaneurol.2021.2043
McCrea, Michael A.; Giacino, Joseph T.; Barber, Jason; et al.
Patients with moderate to severe traumatic brain injury (msTBI) often made significant functional improvements between 2 weeks and 12 months after their injuries, according to new research. "Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI," the researchers report. The prospective cohort study, conducted at 18 level 1 trauma centers around the United States between 2014 and 2018, included 484 participants with msTBI (Glasgow Coma Scale scores 3-12), part of a larger group of patients with TBI from the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. The patients — 362 with severe TBI and 122 with moderate TBI — were tested for outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. At 2 weeks, 12.4% of patients with severe TBI and 41% of those with moderate TBI had favorable outcomes (Glasgow Outcome Scale–Extended scores 4-8). Additionally, 93.5% of the severe TBI group and 78.6% of the moderate TBI group had moderate disability or worse, as measured by the Disability Rating Scale. One year after their injuries, 52.4% of those with severe TBI and 75% of those with moderate TBI had favorable outcomes, while 19.3% and 32%, respectively, reported no disability. Additionally, 78% of the 79 patients who were in a vegetative state at 2 weeks had regained consciousness by 12 months, and 25% of the 56 with available data had regained orientation by that time. The findings, write the researchers, highlight the need for caution when making early, definitive statements during discussions of prognosis suggestive of poor outcomes and possible withdrawal of life-sustaining treatment in the first 2 weeks following a patient's msTBI.