New Study on Traumatic Brain Injury Finds Improved Outcomes Possible Well after Injury
Milwaukee, July 26, 2021 – A study group from Medical College of Wisconsin, Harvard Medical School and University of California, San Francisco published a new paper in JAMA Neurology titled “Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study”. Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the United States with an average of 166 people dying per day according to the CDC. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI. The group found that many patients with severe acute injury achieve favorable outcomes over the course of the first year. This finding is vital as many critical decisions that impact outcomes, including withdrawal of life-sustaining treatment, are made within a few weeks of injury by clinicians.
“This paper adds to the growing body of evidence that many of our past assumptions on recovery from severe traumatic brain injury need to be reexamined. The rush to judgment we often see in the early days after injury may be placing arbitrary limits on patients remarkable potential to recover and rehabilitative treatments that may help. For the thousands of people and families impacted each year we need to ensure we are providing every chance possible to achieve the best recovery possible,” Joseph T. Giacino, PhD, co-first author of the study, Director of Rehabilitation Neuropsychology at Spaulding Rehabilitation Network and Professor of Physical Medicine and Rehabilitation at Harvard Medical School.
The findings from the 484 participants with msTBI at 12 months postinjury showed that approximately half of the participants with severe TBI and three-quarters of those with moderate TBI recovered the ability to function independently at home for at least 8 hours per day. Among participants who remained unconscious in a vegetative state at 2 weeks, 77% recovered consciousness and 25% were fully oriented by 12 months. Among the sample as a whole, participants frequently demonstrated major functional gains between 2 weeks and 12 months postinjury, including the ability to function independently at home for at least 8 hours a day.
“These findings should not be misinterpreted to imply an overly optimistic picture of outcomes after moderate to severe traumatic brain injury because a high proportion of participants were left with considerable disabilities,” Michael A. McCrea, PhD, co-first author of the study, professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin said. “However, these data further inform the natural history of recovery after moderate to severe traumatic brain injury and indicate that a sizeable subset of these patients can achieve meaningful improvement in life function over the first year after injury. These findings wield important translational implications for early clinical management of patients with moderate to severe traumatic brain injury.”
The study was part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study. It 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.
The authors concluded, “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.” The results of the study have important implications for clinical practice, including early decisions about goals of care, prognostic counseling and resource allocation.
“While a substantial proportion of patient die or suffer lasting disability, our study adds to growing evidence that severe acute impairment does not portend uniformly poor long-term outcome,” said senior author Geoffrey Manley, MD, PhD, professor and vice chair of neurological surgery at UCSF and chief of neurosurgery at Zuckerberg San Francisco General Hospital. “Even those patients in a vegetative state – an outcome viewed as dire – may improve, since this is a dynamic condition that evolves over the first year.”
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