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

Abstract

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.

β-Blockers for traumatic brain injury: A systematic review and meta-analysis

“…Our pooled analyses also indicate that β-blockers improved long-term functional outcome in TBI (OR, 1.75; 95% CI, 1.09–2.80; I 2 = 0%; p = 0.02). However, in the index study of 1,615 TBI patients, Schroeppel et al 54 concluded that β-blockers were not predictive of outcomes after discharge. In addition, despite this potential beneficial effect of β-blockers on long-term outcomes, the similar result has not been found at hospital discharge in our meta-analysis.…”

Management of Severe Traumatic Brain Injury in Pediatric Patients

“…However, long-term consequences of TBI include increased likelihood of mortality, vegetative status, physical disabilities, cognitive impairment, psychiatric disorders, seizures, and unemployment rate (Stocchetti and Zanier, 2016). Younger age was associated with higher likelihood of survival at follow-up in an adult trauma center patient cohort (Schroeppel et al, 2020). Based on a retrospective study on TBI outcomes in children, it was found that children under 2 years old who experienced TBI were more likely to experience vomiting and post-traumatic epilepsy as the most common symptom (Hwang et al, 2019).…”