Individual Prognostication of Emergence From Posttraumatic Amnesia: A Nationwide Cohort Study.

OBJECTIVE

To predict individual emergence from posttraumatic amnesia (PTA) in patients with moderate to severe traumatic brain injury (TBI).

DESIGN

Prospective nationwide cohort study based on data from a national registry: Danish Head Trauma Database.

SETTING

Two highly specialized neurorehabilitation hospitals in Denmark.

PARTICIPANTS

Patients with TBI (N=1606) admitted between 2004 and 2020 were included in the study.

INTERVENTIONS: No treatment effects were tested in the study, but participants were admitted for highly specialized neurorehabilitation.

MAIN OUTCOME MEASURES: Duration of PTA, defined as the number of days from TBI onset until regaining anterograde memory function, is a proxy for the resolution of the confusional state. Using competing risk survival analyses, we estimated absolute risks (probabilities) of emerging from PTA according to the included covariates of interest: sex, age, severity of TBI, and time since injury.

RESULTS

A total of 955 patients with TBI (mean age, 45.2; [SD, 17.8], 21% women) were included in the study, of which 658 emerged from PTA within 1 year. In the fully adjusted model, male sex, older age, and greater TBI severity were associated with a lower probability of emerging from PTA. Among patients with severe TBI, 99 of 100 in the youngest age group will emerge from PTA within 1 year, compared with 72 of 100 in the oldest age group. Among patients with very severe TBI, the corresponding estimated probabilities are 62 and 24 of 100 within 1 year, respectively.

CONCLUSIONS

The prognostic model offers clinicians an evidence-based tool to individually predict the probability of emergence from PTA in patients with TBI, incorporating key prognostic factors while accounting for competing risks such as mortality and nonemergence.