Characteristics and recovery trends of severe TBI patients with a favorable functional outcome at 6-month follow-up

Abstract

Traumatic Brain Injury (TBI) is a devastating cause of death and disability. Outcomes following TBI have been extensively studied; however, less attention has been given to identifying characteristics of individuals who have a favorable outcome following severe TBI. We conducted a retrospective analysis of a database containing information on TBI patients admitted to a level 1 trauma center between 2015 and 2021. We focused on patients who were initially admitted with severe TBI (GCS 8 or lower), and had a final favorable functional outcome (GOSE 5 or higher), at six months. Our investigation aimed to identify factors associated with early in-hospital recovery versus delayed post-discharge recovery, as well as factors associated with moderate disability versus good recovery in six-month follow-up, the time that all investigated patients had achieved a favorable outcome. A total of 513 patients were included in the study. Of these, 67.2% achieved early in-hospital recovery, while 32.8% experienced delayed post-discharge recovery. Features such as anisocoric or fixed pupillary light reflex, subarachnoid hemorrhage, intraventricular hemorrhage and, the need for decompressive craniectomy, and tracheostomy were independently associated with delayed recovery in severe TBI patients. Among the 513 patients, 105 (20.4%) had moderate disability, while 408 (79.6%) were in good recovery at the six-month follow-up. Midline shift greater than 5 mm and the need for tracheostomy were independently associated with moderate disability. Our study offers insights into characteristics of severe TBI patients with a favorable outcome at six months. Our results suggest that it may be premature to predict a poor prognosis for patients with severe TBI who do not show early improvement after their injury. Interestingly, approximately one third of patients with a favorable six-month outcome fell into this category.

Keywords: Favorable outcome; Functional outcome; Glasgow outcome scale extended; Recovery; Traumatic brain injury.