Skip to main content

Advertisement

Log in

Clinical Outcomes after Traumatic Brain Injury

  • Neurotrauma (M Kumar, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

Abstract

Traumatic brain injury (TBI) is a major cause of death and disability that often affects young people. After injury, the degree of recovery can be highly variable, with some people regaining near complete function while others remain severely disabled. Understanding what factors influence recovery is important for counseling patients and families in the acute period after injury and can help guide therapeutic decisions in the acute period following injury. In this review, prognostic algorithms useful for clinicians are discussed. Tools for grading patient outcomes, their role in clinical care and research studies, and their limitations are reviewed. Ongoing work focusing on the development of biomarkers to track TBI recovery and the refinement of clinical outcome metrics is summarized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Faul M, Coronado V. Epidemiology of traumatic brain injury. Hand Clin Neurol. 2015;127:3–13.

    Article  Google Scholar 

  2. Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury. J Head Trauma Rehabil. 2006;21:375–8.

    Article  PubMed  Google Scholar 

  3. Ghajar J. Traumatic brain injury. Lancet. 2000;356:923–9.

    Article  CAS  PubMed  Google Scholar 

  4. Polinder S, Meerding WJ, Mulder S, et al. Assessing the burden of injury in six European countries. Bull World Health Org. 2007;85:27–34.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Thurman DJ. Head trauma: basic, preclinical, and clinical directions. New York: Wiley and Sons; 2001.

    Google Scholar 

  6. Kong DF, Lee KL, Harrell FE, et al. Clinical experience and predicting survival in coronary disease. Arch Int Med. 1989;149:1177–81.

    Article  CAS  Google Scholar 

  7. Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5:1251–61.

    Article  Google Scholar 

  8. Trial Collaborators MRCCRASH. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336:425–9.

    Article  Google Scholar 

  9. Jennett B, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R. Predicting outcome in individual patients after severe head injury. Lancet. 1976;307:1031–6.

    Article  Google Scholar 

  10. Servadei F, Murray GD, Penny K, et al. The value of the worst computed tomographic scan in clinical studies of moderate and severe head injury. Neurosurgery. 2000;46:70–5.

    Article  CAS  PubMed  Google Scholar 

  11. Oddo M, Levine J, MacKenzie L, et al. Brain hypoxia is associated with short-term outcome after severe traumatic brain injury independently of intracranial hypertension and low cerebral perfusion pressure. Neurosurgery. 2011;69:1037–45.

    PubMed  Google Scholar 

  12. Madden LK, DeVon HA. A systematic review of the effects of body temperature on outcome after adult traumatic brain injury. J Neurosci Nurs. 2015;47:190–203.

    Article  PubMed  Google Scholar 

  13. Jeremitsky E, Omert LA, Wilberger J, Rodriguez A. The impact of hyperglycemia on patients with severe brain injury. Crit Care Med. 2005;30:47–50.

    Google Scholar 

  14. Tremblay MH, McEwen J. Glucose control and mortality in patients with severe traumatic brain injury. Neurocrit Care. 2009;11:311–6.

    Article  PubMed  Google Scholar 

  15. Bosarge PL, Shoultz TH, Griffin RL, Kerby JD. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury. J Trauma Acute Care Surg. 2015;79:289–94.

    Article  CAS  PubMed  Google Scholar 

  16. Chhabra G, Sharma S, Subramanian A, et al. Coagulaopathy as prognostic marker in acute traumatic brain injury. J Emerg Trauma Shock. 2013;6:180–5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Howard JL, Cipolle MD, Anderson M, et al. Outcome after decompressive craniectomy for the treatment of severe traumatic brain injury. J Trauma. 2008;65:380–5.

    Article  PubMed  Google Scholar 

  18. Honeybul S, Ho KM, Lind CRP, Gillett GR. Validation of the CRASH model in the prediction of 18-month mortality and unfavorable outcome in severe traumatic brain injury requiring decompressive craniectomy. J Neurosurg. 2014;120:1131–7.

    Article  PubMed  Google Scholar 

  19. Olivecrona M, Olivecrona Z. Use of the CRASH study prognosis calculator in patients with severe traumatic brain injury treated with an intracranial pressure-targeted therapy. J Clin Neurosci. 2013;20:996–1001.

    Article  PubMed  Google Scholar 

  20. Menon DK. Unique challenges in clinical trials in traumatic brain injury. Crit Care Med. 2009;37:S129–35.

    Article  PubMed  Google Scholar 

  21. Shukla D, Devi BI, Agrawal A. Outcome measures for traumatic brain injury. Clin Neurol Neurosurg. 2011;113:435–41.

    Article  PubMed  Google Scholar 

  22. Wilson JTL, Teasdale GM. Structured interviews for the Glasgow Outcome Scale and the Extended Glasgow Outcome Scale: guidelines for their use. J Neurotrauma. 1998;15:573–85.

    Article  CAS  PubMed  Google Scholar 

  23. Teasdale GM, Wilson JTL, Murray G, Jennett B. Analyzing outcome of treatment of severe head injury: a review and update on advancing the use of the Glasgow Outcome Scale. J Neurotrauma. 1998;15:587–97.

    Article  CAS  PubMed  Google Scholar 

  24. Weir J, Butcher I, Lu J, Roozenbeek B. Does the extended Glasgow Outcome Scale add value to the conventional Glasgow Outcome Scale? J Neurotrauma. 2012;29:53–8. Study compared GOS and GOS-E and made recommendation to use GOS-E in clinical TBI trials.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Poon W, Vos P, Muresanu D, Vester J, von Wild K, Hömberg V, et al. Cerebrolysin Asian Pacific Trial in acute brain injury and neurorecovery: design and methods. J Neurotrauma. 2015;32:571–80.

    Article  PubMed  Google Scholar 

  26. Mukherjee P, Cheong M, Dams-O’Connor K. Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury. J Neurotrauma. 2013;30:1831–44. Discusses feasibility of using common data elements to monitor patients with TBI in a systematic way.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Menon DK, Steyerberg EW, Citerio G, et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Neurosurgery. 2015;76:67–80.

    Article  PubMed  Google Scholar 

  28. Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367:2471–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Sinclair HL, Rodriguez A, Harris BA, Battison CG, Murray GD. Hypothermia for intracranial hypertension after traumatic brain injury. N Engl J Med 2015;:151007070032002 [epub ahead of print].

  30. Wright DW, Yeatts SD, Silbergleit R. Very early administration of progesterone for acute traumatic brain injury. N Engl J Med. 2014;371:2457–66.

    Article  PubMed  PubMed Central  Google Scholar 

  31. van der Hoop RG, MacAllister T, Stocchetti N. A clinical trial of progesterone for severe traumatic brain injury. N Engl J Med. 2014;371:2467–71.

    Article  PubMed  Google Scholar 

  32. Chou SH, Robertson CS. Monitoring biomarkers of cellular injury and death in acute brain injury. Neurocrit Care. 2014;21:S187–214.

    Article  PubMed  Google Scholar 

  33. Czeiter E, Mondello S, Kovacs N, et al. Brain injury biomarkers may improve the predictive power of the IMPACT outcome calculator. J Neurotrauma. 2012;29:1770–8.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Papa L, Heaton S, Schmalfuss I, Gabrielli A. Biomarkers improve clinical outcome predictors of mortality following non-penetrating severe traumatic brain injury. Neurocrit Care. 2014;22:52–64.

    Article  Google Scholar 

  35. Reis C, Wang Y, Akyol O, Ho W, Stier G, Martin R, et al. What’s new in traumatic brain injury: update on tracking, monitoring and treatment. Int J Molec Sci. 2015;16:11903–65.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Danielle K. Sandsmark.

Ethics declarations

Conflict of Interest

Danielle K. Sandsmark declares that she has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Neurotrauma

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sandsmark, D.K. Clinical Outcomes after Traumatic Brain Injury. Curr Neurol Neurosci Rep 16, 52 (2016). https://doi.org/10.1007/s11910-016-0654-5

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-016-0654-5

Keywords

Navigation