Reserves, Injury Severity, and Outcomes in Traumatic Brain Injury: A CENTER-TBI Observational Study

Area of Science:

• Neuroscience
• Neurology
• Trauma research

Background:

• Traumatic brain injury (TBI) outcomes are influenced by the brain's reserve capacity.
• Understanding how pre-injury factors interact with injury severity is crucial for predicting recovery.

Purpose of the Study:

• To investigate if pre-injury brain reserve proxies (education, age, psychiatric history) predict outcomes differently across TBI severity levels.
• To determine if the impact of TBI severity varies across functional, symptomatic, and cognitive outcomes.

Main Methods:

• Observational cohort study using CENTER-TBI data (n=3377).
• Assessed functional outcome (GOSE), symptoms (RPQ), and cognition.
• Categorized TBI severity (mild, moderate, severe) and analyzed interactions with reserve proxies.

Main Results:

• Higher education and no psychiatric history predicted better outcomes across all TBI severities.
• Age influenced cognition less in severe TBI; younger age correlated with better functional and cognitive scores.
• Symptom burden (RPQ) peaked in middle-aged adults and plateaued in moderate TBI; cognitive performance varied non-linearly with severity.

Conclusions:

• Pre-injury reserve significantly predicts TBI recovery, largely independent of injury severity.
• Functional outcomes show a graded response to increasing TBI severity.
• Symptom and cognitive impairments present complex, non-linear patterns across different TBI severity levels.