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Functional Outcomes Over the First Year After Moderate to Severe Traumatic Brain Injury in the Prospective, Longitudinal TRACK-TBI Study.
McCrea, Michael A; Giacino, Joseph T; Barber, Jason; Temkin, Nancy R; Nelson, Lindsay D; Levin, Harvey S; Dikmen, Sureyya; Stein, Murray; Bodien, Yelena G; Boase, Kim; Taylor, Sabrina R; Vassar, Mary; Mukherjee, Pratik; Robertson, Claudia; Diaz-Arrastia, Ramon; Okonkwo, David O; Markowitz, Amy J; Manley, Geoffrey T; Adeoye, Opeolu; Badjatia, Neeraj; Bullock, M Ross; Chesnut, Randall; Corrigan, John D; Crawford, Karen; Duhaime, Ann-Christine; Ellenbogen, Richard; Feeser, V Ramana; Ferguson, Adam R; Foreman, Brandon; Gardner, Raquel; Gaudette, Etienne; Goldman, Dana; Gonzalez, Luis; Gopinath, Shankar; Gullapalli, Rao; Hemphill, J Claude; Hotz, Gillian; Jain, Sonia; Keene, C Dirk; Korley, Frederick K; Kramer, Joel; Kreitzer, Natalie; Lindsell, Chris; Machamer, Joan; Madden, Christopher; Martin, Alastair; McAllister, Thomas; Merchant, Randall; Ngwenya, Laura B; Noel, Florence.
Afiliação
  • McCrea MA; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
  • Giacino JT; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.
  • Barber J; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.
  • Temkin NR; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
  • Nelson LD; Department of Neurological Surgery, University of Washington, Seattle.
  • Levin HS; Department of Neurological Surgery, University of Washington, Seattle.
  • Dikmen S; Department of Neurosurgery, Medical College of Wisconsin, Milwaukee.
  • Stein M; Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.
  • Bodien YG; Department of Neurological Surgery, University of Washington, Seattle.
  • Boase K; Department of Family Medicine and Public Health, University of California, San Diego, San Diego.
  • Taylor SR; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts.
  • Vassar M; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston.
  • Mukherjee P; Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts.
  • Robertson C; Department of Neurological Surgery, University of Washington, Seattle.
  • Diaz-Arrastia R; Neurological Surgery, University of California, San Francisco, San Francisco.
  • Okonkwo DO; Neurological Surgery, University of California, San Francisco, San Francisco.
  • Markowitz AJ; Neurological Surgery, University of California, San Francisco, San Francisco.
  • Manley GT; Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas.
  • Adeoye O; Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
  • Badjatia N; Neurological Surgery, University of California, San Francisco, San Francisco.
  • Bullock MR; Neurological Surgery, University of California, San Francisco, San Francisco.
  • Corrigan JD; University of Cincinnati, Cincinnati, Ohio.
  • Crawford K; University of Maryland, College Park.
  • Duhaime AC; University of Miami, Coral Gables, Florida.
  • Ellenbogen R; University of Washington, Seattle.
  • Feeser VR; Ohio State University, Columbus.
  • Ferguson AR; University of Southern California, Los Angeles.
  • Foreman B; Massachusetts General Hospital for Children, Boston.
  • Gardner R; University of Washington, Seattle.
  • Gaudette E; Virginia Commonwealth University, Richmond.
  • Goldman D; University of California, San Francisco, San Francisco.
  • Gonzalez L; University of Cincinnati, Cincinnati, Ohio.
  • Gopinath S; University of California, San Francisco, San Francisco.
  • Gullapalli R; University of Southern California, Los Angeles.
  • Hemphill JC; University of Southern California, Los Angeles.
  • Hotz G; TIRR Memorial Hermann, Houston, Texas.
  • Jain S; Baylor College of Medicine, Houston, Texas.
  • Keene CD; University of Maryland, College Park.
  • Korley FK; University of California, San Francisco, San Francisco.
  • Kramer J; University of Miami, Coral Gables, Florida.
  • Kreitzer N; University of California, San Diego, La Jolla.
  • Lindsell C; University of Washington, Seattle.
  • Machamer J; University of Michigan, Ann Arbor.
  • Madden C; University of California, San Francisco, San Francisco.
  • Martin A; University of Cincinnati, Cincinnati, Ohio.
  • McAllister T; Vanderbilt University, Nashville, Tennessee.
  • Merchant R; University of Washington, Seattle.
  • Ngwenya LB; UT Southwestern Medical Center, Dallas, Texas.
  • Noel F; University of California, San Francisco, San Francisco.
JAMA Neurol ; 78(8): 982-992, 2021 08 01.
Article em En | MEDLINE | ID: mdl-34228047
ABSTRACT
Importance Moderate to severe traumatic brain injury (msTBI) is a major cause of death and disability in the US and worldwide. Few studies have enabled prospective, longitudinal outcome data collection from the acute to chronic phases of recovery after msTBI.

Objective:

To prospectively assess outcomes in major areas of life function at 2 weeks and 3, 6, and 12 months after msTBI. Design, Setting, and

Participants:

This cohort study, as part of the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) study, was conducted at 18 level 1 trauma centers in the US from February 2014 to August 2018 and prospectively assessed longitudinal outcomes, with follow-up to 12 months postinjury. Participants were patients with msTBI (Glasgow Coma Scale scores 3-12) extracted from a larger group of patients with mild, moderate, or severe TBI who were enrolled in TRACK-TBI. Data analysis took place from October 2019 to April 2021. Exposures Moderate or severe TBI. Main Outcomes and

Measures:

The Glasgow Outcome Scale-Extended (GOSE) and Disability Rating Scale (DRS) were used to assess global functional status 2 weeks and 3, 6, and 12 months postinjury. Scores on the GOSE were dichotomized to determine favorable (scores 4-8) vs unfavorable (scores 1-3) outcomes. Neurocognitive testing and patient reported outcomes at 12 months postinjury were analyzed.

Results:

A total of 484 eligible patients were included from the 2679 individuals in the TRACK-TBI study. Participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable on demographic and premorbid variables. At 2 weeks postinjury, 36 of 290 participants with severe TBI (12.4%) and 38 of 93 participants with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had moderate disability or worse on the DRS (total score ≥4). By 12 months postinjury, 142 of 271 with severe TBI (52.4%) and 54 of 72 with moderate TBI (75%) achieved favorable outcomes. Nearly 1 in 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0) at 12 months. Among participants in a vegetative state at 2 weeks, 62 of 79 (78%) regained consciousness and 14 of 56 with available data (25%) regained orientation by 12 months. Conclusions and Relevance In this study, patients with msTBI frequently demonstrated major functional gains, including recovery of independence, between 2 weeks and 12 months postinjury. Severe impairment in the short term did not portend poor outcomes in a substantial minority of patients with msTBI. When discussing prognosis during the first 2 weeks after injury, clinicians should be particularly cautious about making early, definitive prognostic statements suggesting poor outcomes and withdrawal of life-sustaining treatment in patients with msTBI.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões Encefálicas Traumáticas Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: JAMA Neurol Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões Encefálicas Traumáticas Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: JAMA Neurol Ano de publicação: 2021 Tipo de documento: Article