Predictors of functional recovery in the first year after severe traumatic brain injury.

INTRODUCTION

Traumatic Brain Injury (TBI) survivors often experience long-term impairments that might decrease their quality of life and functional independence.

OBJECTIVE

This study aimed to identify predictors of functional recovery after severe TBI in Brazil.

METHODS

A prospective observational cohort study was conducted at a trauma referral hospital between May 2021 and May 2022. Individuals with severe TBI (sTBI), defined as having a Glasgow Coma Scale (GCS) score of ≤8 at admission or within 72 h due to head trauma-related causes, were included. Functional recovery was assessed using the Glasgow Outcome Scale-Extended (GOSE) at discharge and 3, 6, and 12 months post-injury. Data on age, sex, cause of injury, GCS scores at admission, Injury Severity Score (ISS), pupillary alterations, decompressive craniectomy, days of mechanical ventilation support (MVS), and education level were extracted from electronic records. Of 172 patients, 145 completed follow-ups.

RESULTS

Patients were mostly male (84.5 %), with low education levels (55.2 %) and an average age of 45. Male sex (OR=9.38, 95 %CI: 1.39, 62.97) and more days of MVS (OR=1.41, 95 %CI: 1.03, 1.48) predicted poor outcomes at discharge. At 3 months, ISS >25 (OR=3.37, 95 %CI: 1.26, 9.03), decompressive craniectomy (OR=3.74, 95 %CI: 1.05, 13.33), more days of MVS (OR=1.18, 95 %CI: 1.07, 1.31), and low (OR=4.44, 95 %CI: 1.19, 16.57) or medium (OR=7.41, 95 %CI: 1.77, 31.02) education levels predicted poorer functional outcomes. At 6 months, decompressive craniectomy (OR=4.31, 95 %CI: 1.37, 13.58), more days of MVS (OR=1.13, 95 %CI: 1.05, 1.21), and a GOSE score ≤6 at discharge were associated with unfavorable functional outcome. At 12 months, age >65 (OR=4.95, 95 %CI: 1.12, 21.84), more days of MVS (OR=1.08, 95 %CI: 1.03, 1.13), and low (OR=6.11, 95 %CI: 1.48, 25.16) or medium (OR=6.48, 95 %CI: 1.49, 28.21) education levels predicted poorer functional recovery.

CONCLUSION

Functional recovery after severe TBI in a low- to middle-income setting is influenced by clinical and sociodemographic factors.