Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study
| Autor: | Opeolu Adeoye, Neeraj Badjatia, Amber Nolan, Dana P. Goldman, Christopher J. Lindsell, Thomas W. McAllister, Seth A. Seabury, Alex B. Valadka, Joel H. Kramer, Joan Machamer, Raquel C. Gardner, Gabriella Satris, Brandon Foreman, Geoffrey T. Manley, Arthur W. Toga, David O. Okonkwo, Ann-Christine Duhaime, Randall Merchant, C. Dirk Keene, Gillian Hotz, Alastair J. Martin, Jonathan Rosand, David M. Schnyer, Michael McCrea, Murray B. Stein, John K. Yue, Sabrina R Taylor, Claudia S. Robertson, Étienne Gaudette, Kevin K.W. Wang, Laura B. Ngwenya, Natalie Kreitzer, M. Ross Bullock, Rao P. Gullapalli, Shankar P. Gopinath, Lindsay D. Nelson, Yelena G. Bodien, J. Claude Hemphill, Karen Crawford, John D. Corrigan, Amy J. Markowitz, Joseph T. Giacino, Mark Sherer, Richard G. Ellenbogen, Christopher J. Madden, Daniel P. Perl, Ross Zafonte, Miri Rabinowitz, V. Ramana Feeser, Mary J. Vassar, Track-Tbi Investigators, Esther L. Yuh, Sureyya Dikmen, Florence Noel, Nancy R. Temkin, Kim Boase, Jason Barber, Angelle M. Sander, Harvey S. Levin, Frederick K. Korley, Luis Gonzalez, Randall M. Chesnut, Eva M. Palacios, Pratik Mukherjee, Adam R. Ferguson, Ava M. Puccio, Ramon Diaz-Arrastia, Sonia Jain |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Moderate to severe
Adult Male Pediatrics medicine.medical_specialty Traumatic brain injury Glasgow Outcome Scale Neuropsychological Tests Cohort Studies Disability Evaluation Interquartile range Activities of Daily Living Brain Injuries Traumatic Medicine Humans In patient Glasgow Coma Scale Longitudinal Studies Prospective Studies Cause of death Original Investigation business.industry Persistent Vegetative State Disability Rating Scale Recovery of Function Middle Aged medicine.disease Prognosis Treatment Outcome Withholding Treatment Female Neurology (clinical) business Cohort study |
| Zdroj: | JAMA Neurol |
| Popis: | Importance Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI. Objective To prospectively assess outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. Design, Setting, and Participants This cohort study, as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, was conducted at 18 level 1 trauma centers in the US from February 2014 to August 2018 and prospectively assessed longitudinal outcomes, with follow-up to 12 months postinjury. Participants were patients with msTBI (Glasgow Coma Scale scores 3-12) extracted from a larger group of patients with mild, moderate, or severe TBI who were enrolled in TRACK-TBI. Data analysis took place from October 2019 to April 2021. Exposures Moderate or severe TBI. Main Outcomes and Measures The Glasgow Outcome Scale–Extended (GOSE) and Disability Rating Scale (DRS) were used to assess global functional status 2 weeks and 3, 6, and 12 months postinjury. Scores on the GOSE were dichotomized to determine favorable (scores 4-8) vs unfavorable (scores 1-3) outcomes. Neurocognitive testing and patient reported outcomes at 12 months postinjury were analyzed. Results A total of 484 eligible patients were included from the 2679 individuals in the TRACK-TBI study. Participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable on demographic and premorbid variables. At 2 weeks postinjury, 36 of 290 participants with severe TBI (12.4%) and 38 of 93 participants with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had moderate disability or worse on the DRS (total score ≥4). By 12 months postinjury, 142 of 271 with severe TBI (52.4%) and 54 of 72 with moderate TBI (75%) achieved favorable outcomes. Nearly 1 in 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0) at 12 months. Among participants in a vegetative state at 2 weeks, 62 of 79 (78%) regained consciousness and 14 of 56 with available data (25%) regained orientation by 12 months. Conclusions and Relevance In this study, patients with msTBI frequently demonstrated major functional gains, including recovery of independence, between 2 weeks and 12 months postinjury. Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI. When discussing prognosis during the first 2 weeks after injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting poor outcomes and withdrawal of life-sustaining treatment in patients with msTBI. |
| Databáze: | OpenAIRE |
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