Time to Follow Commands in Severe Traumatic Brain Injury Survivors With Favorable Recovery at 2 Years

Area of Science:

• Neuroscience
• Trauma Surgery
• Rehabilitation Medicine

Background:

• Long-term recovery in severe traumatic brain injury (TBI) survivors is understudied.
• Time to follow commands is a variable but clinically significant indicator in TBI patients.
• Understanding recovery trajectories is crucial for patient management.

Purpose of the Study:

• To evaluate the time to follow commands in severe TBI patients with favorable outcomes.
• To characterize the recovery trajectory of these patients.
• To identify predictors of delayed cognitive improvement after TBI.

Main Methods:

• Prospective recruitment of 16-80 year olds with severe TBI (Glasgow Coma Scale ≤8) at a Level I trauma center (2003-2018).
• Inclusion criteria included Glasgow Outcome Scale-Extended ≥4 at 2 years post-injury.
• Multivariable linear regression was used to identify predictors of delayed cognitive recovery.

Main Results:

• Out of 580 patients, 140 (24.1%) had favorable outcomes at 2 years; 229 (39.5%) died.
• Mean time to follow commands was 12.7 ± 11.8 days.
• Diffuse axonal injury, intraventricular hemorrhage, and nosocomial infections were associated with significantly longer times to follow commands.

Conclusions:

• Time to follow commands varies widely in severe TBI survivors with favorable outcomes, with most improving within two weeks.
• Diffuse axonal injury, intraventricular hemorrhage, and infections are key factors that can delay acute cognitive recovery.
• Significant recovery is possible up to two years post-injury in TBI patients.