Identifying four distinct prognostic trajectories using latent class growth analysis in moderate-severe TBI: a...

Moderate-to-severe traumatic brain injury (msTBI) is associated with heterogeneous long-term outcomes, yet the dynamic trajectories of functional recovery remain poorly characterized. This study aimed to identify distinct prognostic trajectory subgroups and their risk factors in msTBI patients. A retrospective cohort study was conducted on msTBI patients admitted to our institution. Glasgow Outcome Scale (GOS) scores were assessed at discharge and at 3, 6, 12, and 24 months post-discharge. Latent class growth analysis (LCGA) was employed to identify distinct prognostic trajectories. Univariate analysis and multivariable ordinal regression models were used to identify factors associated with trajectory membership. A total of 401 patients were included in the final analysis. Four distinct prognostic trajectories were identified: (1) Catastrophic Outcome without Recovery (Trajectory 1), (2) Limited Improvement with Unfavorable Outcome (Trajectory 2), (3) Delayed but Sustained Favorable Recovery (Trajectory 3), and (4) Early Stable Favorable Outcome (Trajectory 4). Multivariable ordinal regression analysis identified admission and discharge levels of consciousness (LOC), discharge GOS score, age, and chronic comorbidities as significant independent factors associated with the prognostic trajectories. msTBI patients exhibit heterogeneous long-term recovery patterns that can be classified into four distinct trajectories. Early identification of trajectory membership through baseline clinical characteristics may facilitate personalized rehabilitation strategies and prognostic counseling.