Research Reports - Rehabilitation outcome of unconscious traumatic brain injury patients

J Neurotrauma. 2013 Mar 12

Anke KM, Howell K, Vogler J, Grill E, Straube A, Bender A

Outcome prediction of traumatic brain injury (TBI) patients with severe disorders
of consciousness (DOC) at the end of the 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 MCS (minimally conscious state) 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 bi-weekly 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 achieves 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 post-injury 7 weeks. Keywords: traumatic brain injury, rehabilitation
outcome, clinical course, recovery of consciousness.

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