Abstract
Background
Expectation of long-term outcome is an important factor in treatment decision-making after severe traumatic brain injury (sTBI). Conclusive long-term outcome data substantiating these decisions is nowadays lacking. This systematic review aimed to provide an overview of the scientific literature on long-term outcome after sTBI.
Methods
A systematic search was conducted using PubMed from 2008 to 2020. Studies were included when reporting long-term outcome ≥ 2 years after sTBI (GCS 3–8 or AIS head score ≥ 4), using standardized outcome measures. Study quality and risk of bias were assessed using the QUIPS tool.
Results
Twenty observational studies were included. Studies showed substantial variation in study objectives and study methodology. GOS-E (n = 12) and GOS (n = 8) were the most frequently used outcome measures. Mortality was reported in 46% of patients (range 18–75%). Unfavourable outcome rates ranged from 29 to 100% and full recovery was seen in 21–27% of patients. Most surviving patients reported SF-36 scores lower than the general population.
Conclusion
Literature on long-term outcome after sTBI was limited and heterogeneous. Mortality and unfavourable outcome rates were high and persisting sequelae on multiple domains common. Nonetheless, a considerable proportion of survivors achieved favourable outcome. Future studies should incorporate standardized multidimensional and temporal long-term outcome measures to strengthen the evidence-base for acute and subacute decision-making.
Highlights
1. Expectation of long-term outcome is an important factor in treatment decision-making for patients with severe traumatic brain injury (sTBI).
2. Favourable outcome and full recovery after sTBI are possible, but mortality and unfavourable outcome rates are high.
3. sTBI survivors are likely to suffer from a wide range of long-term consequences, underscoring the need for long-term and multi-modality outcome assessment in future studies.
4. The quality of the scientific literature on long-term outcome after sTBI can and should be improved to advance treatment decision-making.
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Acknowledgements
The authors like to thank Jan Schoones for his help in designing the search strategy used in this systematic review.
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This work was supported by Hersenstichting Nederland (Dutch Brain Foundation) for Neurotraumatology Quality Registry (Net-QuRe).
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WP reports to be part of the management team of CENTER-TBI study and to be the principal investigator of the Net-QuRe, Ciao@TBI, RESET-ASDH and the SPARTA trials. Other authors report no conflicts of interest.
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Mostert, C.Q.B., Singh, R.D., Gerritsen, M. et al. Long-term outcome after severe traumatic brain injury: a systematic literature review. Acta Neurochir 164, 599–613 (2022). https://doi.org/10.1007/s00701-021-05086-6
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DOI: https://doi.org/10.1007/s00701-021-05086-6