Research Reports - Recovery over six-months of medical decision making capacity following traumatic brain injury

Arch Phys Med Rehabil. 2014 Aug 21

Triebel KL(1), Martin RC(1), Novack TA(2), Dreer LE(3), Turner C(1), Kennedy R(4), Marson DC(5)

OBJECTIVE: To investigate recovery of medical decision-making capacity (MDC) over
six-months in persons with traumatic brain injury (TBI) stratified by injury
DESIGN: Longitudinal study comparing controls and TBI patients one month after
injury (T1) and six-months after injury (T2).
SETTING: Inpatient TBI rehabilitation unit and outpatient neurology department.
PARTICIPANTS: 60 controls and 91 patients with TBI stratified by injury severity:
27 mild (mTBI), 20 complicated mild (cmTBI), and 44 moderate/severe (msevTBI).
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: We used the Capacity to Consent to Treatment Instrument
(CCTI) to evaluate MDC performance on five consent standards (expressing choice,
reasonable choice, appreciation, reasoning, and understanding). We also assigned
capacity impairment ratings on the consent standards to each TBI participant
using cut-scores referenced to control performance.
RESULTS: Control performance was stable across time on the consent standards.
Patients with mTBI and cmTBI performed below controls on the understanding
standard at T1 but not T2. Patients with msevTBI performed below controls on
appreciation, reasoning, and understanding at T1 and on appreciation and
understanding at T2, but showed substantial improvement over time.
CONCLUSIONS: Regardless of injury severity, all groups with TBI demonstrated
baseline impairment of MDC with subsequent partial or full recovery of MDC over a
six-month period. However, a sizeable proportion of individual TBI patients in
each group continued to demonstrate capacity compromise at six-months
post-injury. Clinically this finding suggests that individuals with TBI,
regardless of injury severity, need continued monitoring regarding MDC for at
least six-months after injury.

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