Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study

Daniel Vieira de Oliveira; Rita de Cássia Almeida Vieira; Leonardo Zumerkorn Pipek; Regina Marcia Cardoso de Sousa; Camila Pedroso Estevam de Souza; Eduesley Santana-Santos; Wellingson Silva Paiva

doi:10.3390/jcm11216466

Long-Term Outcomes in Severe Traumatic Brain Injury and Associated Factors: A Prospective Cohort Study

J Clin Med. 2022 Oct 31;11(21):6466. doi: 10.3390/jcm11216466.

Authors

Daniel Vieira de Oliveira¹, Rita de Cássia Almeida Vieira², Leonardo Zumerkorn Pipek¹, Regina Marcia Cardoso de Sousa², Camila Pedroso Estevam de Souza³, Eduesley Santana-Santos⁴, Wellingson Silva Paiva¹

Affiliations

¹ Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Rua Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-010, SP, Brazil.
² School of Nursing, University of Sao Paulo, Sao Paulo 05403-000, SP, Brazil.
³ Department of Statistical and Actuarial Sciences, University of Western Ontario, London, ON N6A 3K7, Canada.
⁴ Nursing Department, University of Sergipe, São Cristóvão 49100-000, SE, Brazil.

Abstract

Objective: The presence of focal lesion (FL) after a severe traumatic brain injury is an important factor in determining morbidity and mortality. Despite this relevance, few studies show the pattern of recovery of patients with severe traumatic brain injury (TBI) with FL within one year. The objective of this study was to identify the pattern of recovery, independence to perform activities of daily living (ADL), and factors associated with mortality and unfavorable outcome at six and twelve months after severe TBI with FL.

Methodology: This is a prospective cohort, with data collected at admission, hospital discharge, three, six, and twelve months after TBI.

Results: The study included 131 adults with a mean age of 34.08 years. At twelve months, 39% of the participants died, 80% were functionally independent by the Glasgow Outcome Scale Extended, 79% by the Disability Rating Scale, 79% were independent for performing ADLs by the Katz Index, and 53.9% by the Lawton Scale. Report of alcohol intake, sedation time, length of stay in intensive care (ICU LOS), Glasgow Coma Scale, trauma severity indices, hyperglycemia, blood glucose, and infection were associated with death. At six and twelve months, tachypnea, age, ICU LOS, trauma severity indices, respiratory rate, multiple radiographic injuries, and cardiac rate were associated with dependence.

Conclusions: Patients have satisfactory functional recovery up to twelve months after trauma, with an accentuated improvement in the first three months. Clinical and sociodemographic variables were associated with post-trauma outcomes. Almost all victims of severe TBI with focal lesions evolved to death or independence.

Keywords: Glasgow Outcome Scale; outcome; recovery of function; severe traumatic brain injury.

Grants and funding

This research was funded by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001. Process number 23038.018285/2019-21/PROEX PPGN/FMUSP. This research was partially funded by the National Council for Scientific and Technological Development (CNPq), Brazil. DJFS, WSP and AGK are supported by the NIHR Global Health Research Group on Neurotrauma, which was commissioned by the National Institute for Health Research (NIHR) using UK aid from the UK Government (project 16/137/105). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.