Long-Term Outlook for Most With Serious Brain Injury Is Better Than Thought

By Robert Preidt, HealthDay Reporter

A traumatic brain injury (TBI) can cripple patients for the rest of their lives, but new research suggests that many people with moderate-to-severe TBI have better-than-expected long-term outcomes.

The findings show that decisions about halting life-sustaining treatment for these patients should not be made in the first days after the injury, the researchers said.

“TBI is a life-changing event that can produce significant, lasting disability, and there are cases when it is very clear early on that a patient will not recover,” said senior study author Dr. Geoffrey Manley. He is vice chair of neurological surgery at the University of California, San Francisco, and chief of neurosurgery at Zuckerberg San Francisco General Hospital.

“But results from this study show a significant proportion of our participants experienced major improvements in life functioning, with many regaining independence between two weeks and 12 months after injury,” he said in a university news release.

For the study, Manley’s team followed 484 patients, aged 17 and older, with moderate-to-severe TBI. At two weeks post-injury, 93% of severe TBI patients and 79% of moderate TBI patients had moderate-to-severe disability, and 80% required assistance in basic daily functioning.

But by 12 months, half of the severe TBI patients and three-quarters of the moderate TBI patients could function independently at home for at least eight hours a day. Also, 19% of the severe TBI patients had no disability, and another 14% had only mild disability, the findings showed.

Of the 62 patients who had been in a vegetative state, all had recovered consciousness after 12 months, and 14 out of the 56 with available data (one in four) had regained orientation, meaning they knew who they were, their location and the date. All but one of the patients in this group recovered at least basic communication ability.

The study was published online recently in JAMA Neurology.

“Withdrawal of life-sustaining treatment based on early prediction of poor outcome accounts for most deaths in patients hospitalized with severe TBI,” Manley said.

He pointed out that 64 of the 92 deaths among patients in the study occurred within two weeks of their brain injury.

“While a substantial proportion of patients die or suffer lasting disability, our study adds to growing evidence that severe acute impairment does not portend uniformly poor long-term outcome,” Manley said. “Even those patients in a vegetative state — an outcome viewed as dire — may improve, since this is a dynamic condition that evolves over the first year.”