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Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
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One-Year Outcomes After Traumatic Brain Injury and Early Extracranial Surgery in the TRACK-TBI Study
Christopher J Roberts1,2, Amelia W Maiga3,4,5, Jason Barber6
1Department of Anesthesiology, Medical College of Wisconsin, Milwaukee.
JAMA Network Open
|October 10, 2025
Summary
Early extracranial (EC) surgery after traumatic brain injury (TBI) is linked to worse outcomes in moderate-severe TBI or those with CT scan abnormalities. This association was not observed in orthopedic trauma or CT-negative TBI cases.
Area of Science:
- Neurosurgery
- Trauma Surgery
- Neurocritical Care
Background:
- Traumatic brain injury (TBI) can lead to significant long-term cognitive and functional deficits.
- Extracranial (EC) surgery is sometimes necessary following TBI, but its impact on outcomes requires further investigation.
- Early exposure to EC surgery after TBI has been anecdotally linked to increased cognitive risks.
Purpose of the Study:
- To determine if EC surgery during the initial TBI hospitalization is associated with poorer outcomes at one year post-injury.
- To compare outcomes between TBI patients who underwent EC surgery and those who did not.
Main Methods:
- A retrospective analysis of the prospective, observational TRACK-TBI cohort study.
- Inclusion criteria: patients aged 17+ admitted from ED within 24 hours of trauma, with known GCS and head CT, and no intracranial surgery.
- Comparison groups included orthopedic trauma controls (OTCs), moderate-severe TBI (GCS 3-12), and CT-positive (CT+) or CT-negative (CT-) TBI with GCS 13-15. Outcomes assessed at 1 year using GOSE-TBI, Trails A/B, DRS, and QOLIBRI-OS.
Main Results:
- In the CT+ TBI and moderate-severe TBI subgroups, EC surgery was associated with significantly worse Glasgow Outcome Scale-Extended (GOSE-TBI), Trails Part B, and Disability Rating Scale (DRS) scores at 1 year.
- The Quality of Life After Brain Injury-Overall Scale (QOLIBRI-OS) was also worse in the moderate-severe TBI subgroup following EC surgery.
- No significant association between EC surgery and outcomes was found in the orthopedic trauma control or CT-negative TBI subgroups.
Conclusions:
- Early EC surgery following TBI is associated with adverse functional and cognitive outcomes in patients with moderate-severe TBI or radiographic abnormalities on CT.
- The timing of EC surgery or other interventions may play a role in mitigating long-term deficits.
- Further research is needed to explore strategies for improving outcomes in TBI patients requiring EC surgery.
