Which factors have been used to predict outcomes for traumatic brain injury (TBI)?

Answer

Brown and co-authors found the following variables to be predictive of outcome^[78]:

Initial GCS score
Duration of PTA
Amnesia^[79]
Sex
Age
Years of education

A retrospective cohort study by Watanitanon et al found that among patients with moderate TBI, a poor outcome was twice as likely in those aged 45-64 years and five times as likely in patients over age 80 years, than it was in patients aged 18-44 years.^[80]

Cuthbert et al investigated injury severity and sociobiologic and socioeconomic factors to predict discharge location (home vs not to home) in adults with moderate to severe TBI. They found GCS and acute hospital length of stay to be the most predictive in discharges to home versus not to home (ie, higher GSC and shorter LOS were more likely to be discharged to home). They also found that old age was associated with a decreased likelihood of discharge to rehabilitation and more likely to be discharged to subacute rehabilitation.^[81]

Bogner and colleagues found that substance abuse contributed to the prediction of life satisfaction and productivity, while violent etiology was not a significant contributor to prediction.^[82]Corrigan and co-authors found that a lack of pre-injury history of substance abuse and the possession, at the time of follow-up, of gainful employment were associated with higher life satisfaction 1-2 years after TBI.^[83]An evaluation of the employment outcome in patients with moderate to severe TBI found that patients with comorbid psychiatric symptoms and impaired cognitive functioning are at the highest risk of long-term unemployment.^[84]

Three-month GOS scores are powerful independent predictors of long-term outcome after severe TBI.^{[85, 86]}Davis and colleagues found that GCS scores in the field and on the patient's arrival in the emergency department are highly predictive of mortality and of a need for neurosurgical care.^[87]Davis's study also found that an increase in the GCS score from the field to the emergency department is highly predictive of survival. Studies have shown that the level of abnormality on brain computed tomography (CT) scans and the early loss of autoregulation of ICP are predictive of the outcome.^{[88, 89, 90]}

In a secondary analysis of data on 365 patients with moderate or severe TBI from a randomized trial, Badri et al found that average ICP in the first 48 hours of monitoring independently predicted mortality as well as a composite endpoint of functional and neuropsychological outcome at 6 months. Average ICP, however, was not independently associated with neuropsychological functioning.^[91]In patients with severe TBI due to acute subdural hematoma, TBI severity, age and neurological status are the primary factors influencing outcomes, and nonoperative management is associated with a significantly increased mortality risk.^[92]

Further research is needed to develop simple prognostic tools. Improved prognostic tools, if available, would assist clinicians in planning for patients' long-term care and needs.

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Disability Rating Scale (DRS).
Agitated Behavior Scale, developed by John D Corrigan, PhD, ABPP, Professor, Department of Physical Medicine and Rehabilitation, The Ohio State University. Permission for publication granted by Dr. Corrigan.

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Percival H Pangilinan, Jr, MD Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Health System

Percival H Pangilinan, Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

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Brian M Kelly, DO Professor, Medical Director, Division of Orthotics and Prosthetics, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Assistant Program Director, Residency Training Program, University of Michigan Health System

Brian M Kelly, DO is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, Association of Academic Physiatrists

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Joseph E Hornyak, IV, MD, PhD Associate Professor, Department of Physical Medicine and Rehabilitation, University of Michigan Medical School; Consulting Staff, Medical Director of Human Performance Laboratory, Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center

Joseph E Hornyak, IV, MD, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, Association of Academic Physiatrists, American Academy of Cerebral Palsy and Developmental Medicine

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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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Michael T Andary, MD, MS Professor, Residency Program Director, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine

Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, Association of Academic Physiatrists

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Everett C Hills, MD, MS Assistant Professor of Physical Medicine and Rehabilitation, Assistant Professor of Orthopaedics and Rehabilitation, Penn State Milton S Hershey Medical Center and Pennsylvania State University College of Medicine

Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, Association of Academic Physiatrists, American Academy of Physical Medicine and Rehabilitation, American Association for Physician Leadership, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Pennsylvania Medical Society

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