Recovery Over 6 Months of Medical Decision-Making Capacity After Traumatic Brain Injury

Triebel, Kristen L.; Martin, Roy C.; Novack, Thomas A.; Dreer, Laura E.; Turner, Crystal; Kennedy, Richard E.; Marson, Daniel C.

doi:10.1016/j.apmr.2014.07.413

Cited by 15 publications

(12 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[24][25][26][27] In addition, we noted in a previous study that the group effects of mTBI on MDC did not always transfer to the individual level. 6 Although the mTBI group as a whole performed statistically equal to healthy controls, Table 5 Number (%) of participants with traumatic brain injury (TBI) exhibiting impaired decision-making capacity across TBI group and time Abbreviations: cmTBI 5 complicated mild traumatic brain injury; msevTBI 5 moderate/severe traumatic brain injury; mTBI 5 mild traumatic brain injury. a number of individuals who had sustained mTBI continued to show some level of MDC impairment a year after injury.…”

Section: Resultsmentioning

confidence: 99%

Twelve-month recovery of medical decision-making capacity following traumatic brain injury

et al. 2016

Self Cite

View full text Add to dashboard Cite

Objective: To investigate recovery of medical decision-making capacity (MDC) over the first year following traumatic brain injury (TBI).Methods: A total of 177 participants (111 persons with TBI and 66 healthy controls) were recruited from an inpatient/outpatient TBI rehabilitation unit and outpatient neurology department. Participants with TBI were classified by injury severity into subgroups: mild TBI (mTBI; n 5 28), complicated mild TBI (cmTBI; n 5 23), and moderate/severe TBI (msevTBI; n 5 60). Control and TBI groups were compared at 1 month (t1), 6 months (t2), and 12 months (t3) postinjury using the Capacity to Consent to Treatment Instrument (CCTI), which evaluates MDC using 5 consent standards: expressing choice, reasonable choice, appreciation, reasoning, and understanding.Results: Relative to controls, no TBI group displayed impairment on CCTI expressing choice or reasonable choice at any timepoint. Those with mTBI had reduced appreciation and understanding at t1, which resolved by t2. The cmTBI and msevTBI groups were impaired on all 3 complex consent standards at t1. While patients with cmTBI improved to a level similar to controls by t3, those with msevTBI remained impaired on reasoning and understanding. Across all TBI groups, notable MDC improvement only occurred over the first 6 months postinjury.Conclusions: Over 1 year, most individuals with mTBI or cmTBI regain MDC, while many individuals with msevTBI have lingering deficits in reasoning and comprehension of treatment information. Clinical recovery of MDC occurs primarily during the first 6 months post-TBI regardless of injury severity. Clinicians can therefore identify MDC outcomes in TBI at 6 months postinjury.Neurology ® 2016;87:1052-1059 GLOSSARY CCTI 5 Capacity to Consent to Treatment Instrument; cmTBI 5 complicated mild traumatic brain injury; GCS 5 Glasgow Coma Scale; GEE 5 generalized estimating equations; GOAT 5 Galveston Orientation and Amnesia Test; MDC 5 decisionmaking capacity; msevTBI 5 moderate/severe traumatic brain injury; mTBI 5 mild traumatic brain injury; TBI 5 traumatic brain injury; UAB 5 University of Alabama at Birmingham.Following traumatic brain injury (TBI), individuals are confronted with numerous medical problems and treatment decisions during acute hospitalization, rehabilitation, and over the course of long-term recovery. Medical issues may include managing medications, following advance directives, or treating orthopedic injuries and secondary complications.1,2 Therefore, it is of clinical importance to determine whether the cognitive and emotional deficits associated with TBI impair a person's medical decision-making capacity (MDC), 3 which includes the ability to comprehend and recall pertinent information and then make logical decisions based upon that information.Previous studies by our group have investigated MDC using the Capacity to Consent to Treatment Instrument (CCTI) in patients with uncomplicated mild TBI (mTBI), complicated mild TBI (cmTBI), and moderate/severe TBI (msevTBI).1,4-6 These stud...

show abstract

Section: Resultsmentioning

confidence: 99%

Twelve-month recovery of medical decision-making capacity following traumatic brain injury

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…6 Neurointensive Care Unit, Department of Anesthesia and Intensive Care Unit, AOU Careggi, Florence, Italy. 7 Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia. 8 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.…”

Section: Supplementary Informationmentioning

confidence: 99%

“…Evaluation of short-term outcomes, as hospital mortality, runs the risk of only partially revealing the problems related to the sequelae of TBI. For this reason, it is essential to explore the disability phenomenon at least 6 months after injury [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

Giugni

Gamberini

Carrara

et al. 2021

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background We leveraged the data of the international CREACTIVE consortium to investigate whether the outcome of traumatic brain injury (TBI) patients admitted to intensive care units (ICU) in hospitals without on-site neurosurgical capabilities (no-NSH) would differ had the same patients been admitted to ICUs in hospitals with neurosurgical capabilities (NSH). Methods The CREACTIVE observational study enrolled more than 8000 patients from 83 ICUs. Adult TBI patients admitted to no-NSH ICUs within 48 h of trauma were propensity-score matched 1:3 with patients admitted to NSH ICUs. The primary outcome was the 6-month extended Glasgow Outcome Scale (GOS-E), while secondary outcomes were ICU and hospital mortality. Results A total of 232 patients, less than 5% of the eligible cohort, were admitted to no-NSH ICUs. Each of them was matched to 3 NSH patients, leading to a study sample of 928 TBI patients where the no-NSH and NSH groups were well-balanced with respect to all of the variables included into the propensity score. Patients admitted to no-NSH ICUs experienced significantly higher ICU and in-hospital mortality. Compared to the matched NSH ICU admissions, their 6-month GOS-E scores showed a significantly higher prevalence of upper good recovery for cases with mild TBI and low expected mortality risk at admission, along with a progressively higher incidence of poor outcomes with increased TBI severity and mortality risk. Conclusions In our study, centralization of TBI patients significantly impacted short- and long-term outcomes. For TBI patients admitted to no-NSH centers, our results suggest that the least critically ill can effectively be managed in centers without neurosurgical capabilities. Conversely, the most complex patients would benefit from being treated in high-volume, neuro-oriented ICUs.

show abstract

“…Therefore, continuous patient monitoring, in terms of patient capacity in making decisions, is essential during the entire processes of treatment ( 17 ). At least a six-month period of monitoring is required in this respect ( 18 ).…”

Section: Introductionmentioning

confidence: 99%

Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran

et al. 2016

View full text Add to dashboard Cite

BackgroundAccording to general ethical and legal principles, valid consent must be obtained before starting any procedure.ObjectivesDue to the lack of a standard tool for assessing patients’ capacity to consent to medical treatment in Iran, the present study was carried out aiming to devise a Persian version of a cross-cultural adaptation of the MacArthur competence assessment tool.Patients and MethodsBy reviewing different methods of cultural translation and adaptation for assessment tools, and due to the lack of consensus on its processes, we selected Wild’s model as one of the most comprehensive methods in this regard. Wild’s (2005) 10-stage model includes preparation, forward translation, reconciliation of the forward translation, back translation of reconciliation, back translation review, cognitive debriefing and cognitive review, and finalization, proofreading and final reporting. Using this model, we translated the MacArthur assessment tool and made it adaptable to Iranian patients.ResultsThe MacArthur assessment tool is not dependent on any specific culture and language. As a result, if translation and its scientific adaptation are done based on an integrated and detailed model, the tool can be used for every culture and language. In other words, this tool is not culture-specific; so, it is applicable in cases where a translation is needed, and it can be culturally adapted to suit different societies.ConclusionsIn the present study, we are able to focus on and prove the efficacy and benefits of this measurement tool.

show abstract

Recovery Over 6 Months of Medical Decision-Making Capacity After Traumatic Brain Injury

Cited by 15 publications

References 29 publications

Twelve-month recovery of medical decision-making capacity following traumatic brain injury

Twelve-month recovery of medical decision-making capacity following traumatic brain injury

Hospitals with and without neurosurgery: a comparative study evaluating the outcome of patients with traumatic brain injury

Cross-Cultural Adaptations of the MacArthur Competence Assessment Tool for Treatment in Iran

Contact Info

Product

Resources

About