Long-term outcome after severe traumatic brain injury: a systematic literature review

Abstract

Background Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI. Methods A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting longterm outcome ≥ 2 years after sTBI (GCS 3-8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool. Results Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18-75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21-27% of patients. Most surviving patients reported SF-36 scores lower than the general population. Conclusion Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making. Highlights 1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI). 2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high. 3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies. 4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.

Predicting Outcome in Patients with Brain Injury: Differences between Machine Learning versus Conventional Statistics

“…Due to the severe social and economic burden of brain injury, the expectation of long-term outcome is an important factor in clinical practice, and this is particularly important after severe traumatic brain injury (TBI), which still presents high mortality and unfavorable outcome rates with a severe global disability [ 1 ].…”

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

“…Following sTBI even though most improvement is believed to take place within the first year, changes in functional outcome, both improvements and deterioration, can continue for several years. Given that TBI often affects young individuals, who are expected to live for decades with their injury, it is important to conduct studies with a longer follow-up interval [ 18 ]. In the Swedish health care system, 3 months after injury most patients are still undergoing inpatient rehabilitation.…”

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

“…Se estima que cada año en el mundo 50 millones de personas sufren un traumatismo craneoencefálico (TCE) [ 1 ]. 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 ]. Estas circunstancias dificultan la generación de modelos predictivos suficientemente precisos como para asistir, convenientemente, a la toma de decisiones clínicas [ 3 ].…”

“…Si bien actualmente es incuestionable que la duración de la APT es un factor predictor de recuperación pos-TCE, apenas se dispone de información sobre qué variables influyen en su duración [ 3 ]. Poder predecir el tiempo que una persona permanece en APT es fundamental para planificar la intervención, ofrecer información adecuada a la familia (ayudándoles a desarrollar expectativas realistas con relación al proceso de recuperación) o incidir en factores modificables (por ejemplo, efecto sedativo de los psicofármacos o uso de neuroestimulantes).…”