Favorable Functional Recovery in Severe Traumatic Brain Injury Survivors beyond Six Months

Wilkins, Tiffany; Beers, Sue R.; Borrasso, Allison J.; Brooks, Jordan; Mesley, Matthew; Puffer, Ross C.; Chang, Yue‐Fang; Okonkwo, David O.; Puccio, Ava M.

doi:10.1089/neu.2018.6153

Cited by 68 publications

(77 citation statements)

References 20 publications

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Section: Introductionmentioning

confidence: 99%

“…Among patients who survive a severe traumatic brain injury (TBI), 7–8% remain in a vegetative state (VS), and 37% remain in a minimally conscious state (MCS) or completely dependent at six months ( Wilkins et al, 2019 ). Alternatively, 17% have a good or near-complete recovery ( Wilkins et al, 2019 ). The lack of accurate prognostic tools in the intensive care unit (ICU) creates uncertainty and increases the risk of premature withdrawal of life-sustaining therapy (WLST) in patients with recovery potential ( Turgeon et al, 2011 , Izzy et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

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Ascending arousal network connectivity during recovery from traumatic coma

Snider

Bodien

Frau-Pascual

et al. 2020

NeuroImage: Clinical

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ascending arousal network connectivity during recovery from traumatic coma

Snider

Bodien

Frau-Pascual

et al. 2020

NeuroImage: Clinical

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“…Natural history of recovery from brain injury can be significantly longer than what is usually recorded and reported. Contemporary series with extended follow-ups provide encouraging data in terms of recovery potential beyond the first year from injury, and show that GOSE categories as reported from trials are not necessarily static end-states (30,31). In terms of DC, surrogates should be also informed about the need of additional future surgery such as cranioplasty, which carries both promise in terms of neurologic function improvement, and concern due to its own moribidity and complications (32).…”

Section: Limitationsmentioning

confidence: 97%

Deciding Under Uncertainty: The Case of Refractory Intracranial Hypertension

Lazaridis

2020

Front. Neurol.

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A challenging clinical conundrum arises in severe traumatic brain injury patients who develop intractable intracranial hypertension. For these patients, high morbidity interventions such as surgical decompression and barbiturate coma have to be considered against a backdrop of uncertain outcomes including prolonged states of disordered consciousness and severe disability. The clinical evidence available to guide shared decision-making is mainly limited to one randomized controlled trial, the RESCUEicp. However, since the publication of this trial significant controversy has been ongoing over the interpretation of the results. Is the mortality benefit from surgery merely a trade off for unacceptable long-term disability? How should treatment options, possible outcomes, and results from the trial be communicated to surrogates? How do we incorporate patient values into forming plans of care? The aim of this article is to sketch an approach based on insights from Decision Theory , and specifically deciding under uncertainty . The mainstream normative decision theory, Expected Utility (EU) theory, essentially says that, in situ ations of uncertainty, one should prefer the option with greatest expected desirability or value. The steps required to compute expected utilities include listing the possible outcomes of available interventions, assigning each outcome a utility ranking representing an individual patient's preferences, and a conditional probability given each intervention. This is a conceptual framework meant to supplement, and enhance shared decision making by assuring that patient values are elicited and incorporated, the possible range and nature of outcomes is discussed, and finally by attempting to connect best available means to patient-individualized ends.

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“…[4][5][6][7][8] Severe TBI carries extensive mortality during the index admission of up to 79% and the long-term mortality, even in those that survive the index admission, is also considerable with a rate of up to 52%. [9][10][11][12][13][14][15] For those patients that do survive the initial hospitalization, a proportion will continue to improve for up to 10 years postdischarge. [16][17][18][19] While controversy exists with respect to which factors are associated with improved functional outcomes after discharge, age and severity of injury are common elements in many studies.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Analysis of Functional Outcomes in Traumatic Brain Injury Patients

Schroeppel

Sharpe

Melendez

et al. 2020

The American Surgeon™

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Introduction Traumatic brain injury (TBI) remains a significant cause of morbidity and mortality. The purpose of this study is to examine outcomes after discharge and identify factors from the index admission that may contribute to long-term mortality. Methods The study population is composed of patients who survived to discharge from a previously published study examining TBI. Demographics, injury severity, and length of stay were abstracted from the index study. Phone surveys of surviving patients were performed to evaluate each patient’s Glasgow Outcome Scale-Extended (GOSE). Patients who were deceased at the time of the survey were compared with those who were alive. Results 1615 patients were alive at the end of the first study period and 211 (13%) comprised the study population. Overall, the median age was 54 years, and the majority were male (74%). The median time to follow-up was 80 months. The population was severely injured, with a median injury severity score (ISS) of 25 and a median head abbreviated injury score (AIS) of 4. Overall mortality was 57%. The group that survived at the time of the survey was younger, more injured, less likely to have received beta-blockers (BB) during the index admission, and had a longer time to follow-up. After adjusting for ISS, age, base deficit, and BB, age was the only variable predictive of mortality (HR 1.03; HL 1.02-1.04). Conclusion Despite being more severely injured, younger patients were more likely to survive to follow-up. Further investigation is needed to determine if aggressive care in older TBI patients in the acute phase leads to good long-term outcomes.

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Favorable Functional Recovery in Severe Traumatic Brain Injury Survivors beyond Six Months

Cited by 68 publications

References 20 publications

Ascending arousal network connectivity during recovery from traumatic coma

Ascending arousal network connectivity during recovery from traumatic coma

Deciding Under Uncertainty: The Case of Refractory Intracranial Hypertension

Long-Term Analysis of Functional Outcomes in Traumatic Brain Injury Patients

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