Prognostication of Mortality and Long-Term Functional Outcomes Following Traumatic Brain Injury: Can We Do Better?

Accurate prognostication of outcomes following traumatic brain injury (TBI) affects not only the aggressiveness of intervention and therapeutic decision-making but also clinicians' ability to provide reliable expectations. To investigate the relative ability of clinicians to accurately predict a patient's outcomes, compared with point-of-care prognostic models, we surveyed clinical providers of 86 patients with moderate-severe TBI at admission, Day 3, and Day 7 post-injury for a patient's predicted mortality and functional outcome at 6 months. The predicted mortality and functional outcomes were compared with actual occurrence of 14-day mortality and functional outcomes at six months. A prognostic score was then calculated utilizing the Corticoid Randomization After Significant Head Injury (CRASH) and International Mission on Prognosis and Analysis of Clinical Trials (IMPACT) models and categorized as high, intermediate, and low likelihood of mortality or poor functional outcome, and compared with clinical predictions. Overall, clinicians of varying backgrounds showed an accurate prediction of survival (87.2-97.4%) but struggled in prognosticating poor functional outcomes (24.3-36.6%). These values did not statistically improve over 7 days. Stratified CRASH (87.2%) and IMPACT (84.9%) accuracy rates were statistically better than clinical judgment alone in predicting functional outcomes (p < 0.0001). Prognostic models calculated at admission showed to be potentially useful, in conjunction with clinical judgment, in accurately predicting both survival and 6-month functional outcomes.