Baseline Predictors of Survival, Neurological Recovery, Cognitive Function, Neuropsychiatric Outcomes, and Return to Work in Patients after a Severe Traumatic Brain Injury: an Updated Review

Abstract

Introduction: Severe traumatic brain injury (sTBI) is a common cause of death and disability worldwide, with long-term squeal among survivors that include cognitive deficits, psychosocial and neuropsychiatric dysfunction, failure to return to pre-injury levels of work, school and inter-personal relationships, and overall reduced quality of and satisfaction with life. Aim: The aim of this work is to review the current literature on baseline predictors of outcomes in adults post sTBI. Method: Most of available literature on baseline predictors of outcomes in adults post sTBI were reviewed and summarized in this work. Results: Currently, a sizeable number of composite predictors of mortality and overall function exists; however, these instruments tend to over-estimate poor outcomes and fail to address issues like cognition, psychosocial/ neuropsychiatric dysfunction, and return to work or school. Conclusion: This article reviews currently-identified predictors of all these outcomes.

Variables predictoras de la duración de la amnesia postraumática tras un traumatismo craneoencefálico

“…La edad en el momento del TCE se asocia con el nivel de recuperación: frente a alteraciones neuropsicológicas y neurológicas similares, los pacientes de menor edad acostumbran a mostrar una mejor recuperación que los de mayor edad [ 4 , 7 , 18 , 31 ]. En nuestro estudio, sin embargo, al igual que sucede en los realizados por Gurin et al [ 2 ] y Tate et al [ 24 ], no constatamos que exista relación entre la edad en el momento del TCE y la duración de la APT.…”

“…Estas personas experimentan una disminución de su calidad de vida a causa de las alteraciones neurológicas y neuropsicológicas derivadas del traumatismo [ 2 , 3 ]. La identificación de variables que expliquen la recuperación pos-TCE es fundamental para guiar a los profesionales clínicos en la toma de decisiones relativas al tratamiento, la asignación de recursos y la comunicación con la familia sobre la naturaleza, la intensidad y la duración de la rehabilitación, así como la predicción de posibles secuelas [ 4 , 5 ]. Sin embargo, la estimación del nivel de recuperación pos-TCE es compleja, dada la elevada heterogeneidad lesional y múltiples cursos evolutivos [ 6 , 7 ].…”

Future Perspectives in Spinal Cord Repair: Brain as Saviour? TSCI with Concurrent TBI: Pathophysiological Interaction and Impact on MSC Treatment

“…As TSCI and TBI represent major traumata with profound systemic effects, they are followed by metabolic and immune alterations potentially resulting in energy wasting, systemic inflammatory response syndrome (SIRS) and critical illness with the need for intensive care, which poses a major challenge to regeneration and healing processes ( Section 3.2 , Section 3.3 , Section 3.4 , Section 3.5 , Section 3.6 , Section 3.7 and Section 3.8 ). While isolated TSCI and TBI were reported to result in cognitive impairment [ 8 , 59 , 60 ], TSCI in polytrauma patients [ 61 ] as well as TSCI with concomitant TBI showed additive effects with further reduced cognitive and neuromotor outcomes [ 8 , 59 , 60 , 61 ]. Therefore, long-term mood disorders, polypharmacy, post-intensive care unit syndrome, cortical reorganisation and neuro-inflammation are recognised as additional therapeutic challenges of TSCI with concurrent TBI [ 8 ].…”

Cognitive Reserve, Early Cognitive Screening, and Relationship to Long-Term Outcome after Severe Traumatic Brain Injury

“…Age and acute injury severity consistently play a part in outcomes after sTBI [ 16 ]. Additionally, cognitive reserve, usually approximated by educational level, has been found to influence both the score on neuropsychological tests, including BNIS, and the outcome after sTBI [ 10 , 12 , 16 , 17 ]. However, a relationship between cognitive reserve and a test score does not automatically imply a relationship between test score and recovery.…”