Predictors of Long-term Functional Outcome after Severe Traumatic Brain Injury

Research Objectives: To investigate clinical and sociodemographic factors associated with functional outcome 1 year after severe Traumatic Brain Injury (TBI)

Design: Prospective observational study.

Setting: State Hospital of Urgency and Emergency/Trauma Reference Center.

Participants: All 172 individuals with severe TBI admitted to the emergency room or to the ICU of the reference trauma hospital between May 2021 to May 2022 who survived the hospitalization period were enrolled. Of these, 145 patients completed 1 year follow-up successfully. N=145.

Interventions: N/A.

Main Outcome Measures: Functional outcome assessed using the Glasgow Outcome Scale - Extended (GOS-E) in person at hospital discharge and by telefone after 3, 6 and 12 months after severe TBI.

Results: The individuals included in the analysis were mostly male (85%) with an average age of 45 years (±11). Among these individuals, 80 (55%) had a low level of education and spent an average of 11 days (±8) on mechanical ventilation support. Upon hospital discharge, the majority (91%) of patients exhibited an unfavorable functional outcome (GOSE ≤6). Over the course of 12 months, this proportion reversed, as the number of patients with scores ≤6 on the GOSE decreased, while those with scores >6 increased. At 1 year after the trauma, 48% of patients experienced an unfavorable functional outcome (GOSE ≤6). ISS scores >25, undergoing decompressive craniectomy, extended duration of mechanical ventilation, and low level of education were associated with an increased risk of unfavorable outcomes 3 months after trauma. At 6 months, only undergoing decompressive craniectomy and length of stay in mechanical ventilation were variables associated with a higher risk of scores ≤6 on the GOSE. Lastly, age >65 years, having an extended duration of mechanical ventilation, and possessing a low level of education were associated with an elevated risk of an unfavorable functional outcome 12 months after severe TBI.

Conclusions: According to this study, patients with severe TBI present a high level of disability at hospital discharge. Although the results demonstrate that functional recovery progressively improves 1 year after the injury, disability and mortality rates after hospital discharge were still considerably high in this population. In multivariate analyses, independent predictive factors for an unfavorable long-term outcome were advanced age, length of stay on mechanical ventilation, education level and level of injury severity. This study has limitations such as relatively small group size, single-center configuration and unmeasured covariates that may have influenced the final result.

Author(s) Disclosures: All authors denied any conflicts of interests.