Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study

• DOI: 10.1001/jamaneurol.2021.2043
• Publication Date: 2021-07-06T15:12:53Z
• Authors: Michael A. McCrea; Joseph T. Giacino; Jason Barber; Nancy R. Temkin; Lindsay D. Nelson; Harvey S. Levin; Sureyya Dikmen; Murray Stein; Yelena G. Bodien; Kim Boase; Sabrina R. Taylor; Mary Vassar; Pratik Mukherjee; Claudia Robertson; Ramon Diaz-Arrastia; David O. Okonkwo; Amy J. Markowitz; Geoffrey T. Manley; ; Opeolu Adeoye; Neeraj Badjatia; M. Ross Bullock; Randall Chesnut; John D. Corrigan; Karen Crawford; Ann-Christine Duh...; Richard Ellenbogen; V. Ramana Feeser; Adam R. Ferguson; Brandon Foreman; Raquel Gardner; Etienne Gaudette; Dana Goldman; Luis Gonzalez; Shankar Gopinath; Rao Gullapalli; J. Claude Hemphill; Gillian Hotz; Sonia Jain; C. Dirk Keene; Frederick K. Korley; Joel Kramer; Natalie Kreitzer; Chris Lindsell; Joan Machamer; Christopher Madden; Alastair Martin; Thomas McAllister; Randall Merchant; Laura B. Ngwenya; Florence Noel; Amber Nolan; Eva Palacios; Daniel Perl; Ava Puccio; Miri Rabinowitz; Jonathan Rosand; Angelle Sander; Gabriella Satris; David Schnyer; Seth Seabury; Mark Sherer; Arthur Toga; Alex Valadka; Kevin Wang; John K. Yue; Esther Yuh; Ross Zafonte
• Keywords: Longitudinal Study; Fast track

<h3>Importance</h3> Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US worldwide. Few studies have enabled prospective, longitudinal outcome data collection from acute chronic phases recovery after msTBI. <h3>Objective</h3> To prospectively assess outcomes areas life function at 2 weeks 3, 6, 12 months <h3>Design, Setting, Participants</h3> This cohort study, as part Transforming Research Clinical Knowledge TBI (TRACK-TBI) was conducted 18 level 1 trauma centers February 2014 August 2018 assessed outcomes, with follow-up postinjury. Participants were patients msTBI (Glasgow Coma Scale scores 3-12) extracted larger group mild, moderate, or who enrolled TRACK-TBI. Data analysis took place October 2019 April 2021. <h3>Exposures</h3> TBI. <h3>Main Outcomes Measures</h3> The Glasgow Outcome Scale–Extended (GOSE) Disability Rating (DRS) used global functional status Scores on GOSE dichotomized determine favorable (scores 4-8) vs unfavorable 1-3) outcomes. Neurocognitive testing patient reported postinjury analyzed. <h3>Results</h3> A total 484 eligible included 2679 individuals TRACK-TBI study. (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) moderate 122; 98 [80.3%]; 38 comparable demographic premorbid variables. At postinjury, 36 290 participants (12.4%) 93 (41%) had (GOSE 4-8); 301 322 (93.5%) 81 103 (78.6%) worse DRS (total score ≥4). By 142 271 (52.4%) 54 72 (75%) achieved Nearly 5 (52 270 [19.3%]) 3 (23 71 [32%]) no (DRS 0) months. Among vegetative state weeks, 62 79 (78%) regained consciousness 14 56 available (25%) orientation by <h3>Conclusions Relevance</h3> In this frequently demonstrated gains, including independence, between Severe impairment short term did not portend poor substantial minority When discussing prognosis during first injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting withdrawal life-sustaining treatment