Enhanced Recovery Protocol Post-TBI (ERA-TBI): Factors Determining Morbidity and Mortality

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Public Health

Background:

• Traumatic brain injury (TBI) is a major cause of death and disability globally.
• Enhanced Recovery After Surgery (ERAS) programs show benefits in surgical fields but are fragmented in TBI recovery.
• A structured approach to TBI recovery is needed to reduce outcome variability.

Purpose of the Study:

• To review recovery-phase factors influencing TBI morbidity and mortality.
• To examine rehabilitation strategies, patient demographics, and comorbidities within an Enhanced Recovery After TBI (ERA-TBI) framework.
• To propose patient-centered recovery models for TBI.

Main Methods:

• Narrative review of literature focusing on post-acute TBI recovery.
• Synthesis of evidence across rehabilitation, patient demographics, and comorbidities.
• Consideration of perioperative and acute care only as context for recovery outcomes.

Main Results:

• Early, intensive, multidisciplinary rehabilitation (e.g., mobilization, cognitive interventions) improves neurological recovery, function, and quality of life.
• Emerging technologies like VR and telerehabilitation show promise but require more research.
• Patient factors (age, frailty, socioeconomic status, comorbidities) significantly impact recovery, with access to rehabilitation being a key mediator.

Conclusions:

• ERA-TBI pathways should shift towards stratified, patient-centered models.
• Integrating biological reserve, social context, and comorbidity burden is crucial.
• Standardizing TBI recovery can reduce outcome variability and optimize functional recovery.