Research Reports - Rehabilitation outcome of unconscious traumatic brain injury patients

J Neurotrauma. 2013 Jul 26

Klein AM, Howell K, Vogler J, Grill E, Straube A, Bender A

Abstract Outcome prediction of traumatic brain injury (TBI) patients with severe
disorders of consciousness (DOC) at the end of their time in an intensive care
setting is important for clinical decision making and counseling of relatives,
and constitutes a major challenge. Even the question of what constitutes an
improved outcome is controversially discussed. We have conducted a retrospective
cohort study for the rehabilitation dynamics and outcome of TBI patients with
DOC. Out of 188 patients, 37.2% emerged from a minimally conscious state (MCS)
and 16.5% achieved at least partial functional independence after a mean
observation period of 107 days (range 1-399 days). This reflects that emergence
from MCS is much easier to achieve than functional independence. Logistic
regression analysis identified age and level of consciousness upon admission to
neurorehabilitation as independent prognostic factors for both outcomes. The
group who reached at least partial functional independence started to improve
significantly more than the corresponding outcome group by post-injury week 7,
and the average time to reach this functional status was 18 weeks. In contrast,
the group who emerged from MCS started to improve after 6 weeks. The longest
delay between brain injury and the beginning of functional improvement (measured
by biweekly Functional Independence Measure [FIM] scores) still compatible with
reaching at least partial functional independence was 18 weeks. In conclusion,
despite a strong negative selection, a substantial proportion of severe TBI
patients with DOC achieve functional improvements or at least emerge from MCS
within the inpatient rehabilitation phase. In order to avoid self-fulfilling
prophecies in decision making, it is important to be aware of the fact that the
beginning of clinical improvement may take several months after brain injury. In
this study, separation of both of the functional outcome groups started by 7
weeks post-injury.

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