Traumatic Brain Injury

Outcome and Predictors of Outcome
  • Donald A. Taylor
Part of the Critical Issues in Neuropsychology book series (CINP)


Traumatic brain injury (TBI) affects over 400,000 people each year in the United States (Kalsbeck, McLaurin et al., 1980). Mortality following severe TBI varies between 30% and 60% (Bartkowski & Lovely, 1986). One multicenter study of TBI in an adult population identified 51% mortality with 36% having good recovery or moderate disability and 13% having severe disability or being in a vegetative state (Jennett, Teasdale et al., 1987). In children and adolescents, there was a 33% mortality, 51% of the patients had a good outcome or moderate disability and 16% were severely disabled or were in a vegetative state (Berger, Pitts, & Lovely, 1985). The Medical College of Virginia, demonstrating the value of intensive management, found 30% mortality with 60% good outcome/moderate disability, 8% severe disability, and 2% persistent vegetative state (Becker, Miller et al., 1977). A study of pediatric head injury from the same institution reported 24% mortality, 68% good outcome/moderate disability, 6% severe disability, and 2% persistent vegetative state (Ward & Alberico, 1987). Thus, although good outcome or moderate disability varies widely depending on age and level of care, the incidence of severe disability/vegetative state is relatively constant despite age or type of care. Approximately 40,000 patients will have poor outcome annually with 32,000 being severely disabled and 8000 remaining in a vegetative state.


Traumatic Brain Injury Head Injury Vegetative State Severe Disability Severe Traumatic Brain Injury 
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  1. Adams, J. H., Graham, D. I., et al. (1982). Diffuse axonal injury due to non-missile head injury in humans: An analysis of 45 cases. Annals of Neurology, 12, 557–563.PubMedCrossRefGoogle Scholar
  2. Anderson, D., Bundlie, S., & Rockswold, G. (1984). Multimodality evoked potentials in closed head trauma. Archives of Neurology, 41, 369–379.PubMedCrossRefGoogle Scholar
  3. Bartkowski, H. M., & Lovely, M. P (1986). Prognosis in coma and the persistent vegetative state. Journal of Head Trauma Rehabilitation, 1, 1–5.CrossRefGoogle Scholar
  4. Becker, D. P., Miller, J. D., et al. (1977). The outcome from severe head injury with early diagnosis and intensive management. Journal of Neurosurgery, 47, 491–502.PubMedCrossRefGoogle Scholar
  5. Berger, H. (1931). Uber das elektrnkephalogrqmar des menschen III, Mitteilung. Archiv fuer Psychiatrie und Nervenkrankheiten, 94, 16–60.CrossRefGoogle Scholar
  6. Berger, M. S., Pitts, L. H., & Lovely, M. (1985). Outcome from severe head injury in children and adolescents. Journal of Neurosurgery, 62, 194–199.PubMedCrossRefGoogle Scholar
  7. Bowers, S. A., & Marshall, L. F. (1980). Outcome in 200 consecutive cases of severe head injury treated in San Diego County: A prospective analysis. Neurosurgery, 6, 237–242.PubMedCrossRefGoogle Scholar
  8. Bricolo, A. (1976). Electroencephalography in neurotraumatology. Clinical Electroencephalography, 7,184–197.Google Scholar
  9. Bricolo, A., Turazzi, S., Faccioli, F., Odorizzi, F., Sciarretta, G., & Erculiani, P (1978). Clinical application of compressed spectral array in long term EEG monitoring of comatose patients. Electroencephalography & Clinical Neurophysiology, 45, 211–25.CrossRefGoogle Scholar
  10. Bruce, D. A., et al. (1979). Pathophysiology, treatment and outcome following severe head injury in children. Child’s Brain, 5, 174–191.PubMedGoogle Scholar
  11. Cant, B. R., & Shaw, N. A. (1984). Monitoring by compressed special array in prolonged coma. Neurology, 34,35–39.PubMedCrossRefGoogle Scholar
  12. Chatrian, G. E., White, L. E., & Daly, D. (1963). Electroencephalographic patterns resembling those of sleep in certain comatose states after head injury. Electroencephalography & Clinical Neurophysiology, 15, 272–280.CrossRefGoogle Scholar
  13. Choi, S. C., Ward, J. D., & Becker, D. P (1983). Chart for outcome prediction in severe head injury. Journal of Neurosurgery, 59, 294–297.PubMedCrossRefGoogle Scholar
  14. Facco, E., et al. (1985). Is the auditory brain-stem response (ABR) effective in the assessment of post-traumatic coma? Electroencephalography & Clinical Neurophysiology, 62, 332–337.CrossRefGoogle Scholar
  15. Frank, L. M., Furgiuele, T. L., & Etheridge, J. E. (1985). Prediction of chronic vegetative state in children using evoked potentials. Neurology, 35, 931–934.PubMedCrossRefGoogle Scholar
  16. Gennarelli, T. A., et al. (1982). Influence of the type of intracranial lesion on outcome from severe head injury. Journal of Neurosurgery, 56, 26–32.PubMedCrossRefGoogle Scholar
  17. Gennarelli, T. A., Thibault, L. E., Adams, J. H., et al. (1982). Diffuse axonal injury and traumatic coma in the primate. Annals of Neurology, 12,564–574.PubMedCrossRefGoogle Scholar
  18. Gibbs, F. A., Davis, H., & Lennox, W. G. (1935). The electroencephalogram in epilepsy and in conditions of impaired consciousness. Archives of Neurology & Psychiatry, 34, 1133–1148.CrossRefGoogle Scholar
  19. Goldie, W., Chiappa, K., Young, R., & Brooks, E. (1981). Brain-stem auditory and short-latency somatosensory evoked responses in brain death. Neurology, 31, 248–256.PubMedCrossRefGoogle Scholar
  20. Greenberg, R. P., & Ducker, T. B. (1982). Evoked potentials in the clinical neurosciences. Journal of Neurosurgery, 56, 1–18.PubMedCrossRefGoogle Scholar
  21. Greenberg, R., et al. (1977). Evaluation of brain function in severe human head trauma with multimodality evoked potentials, part 1: Evoked brain-injury potentials, methods, & analysis. Journal of Neurosurgery, 47, 150–162.PubMedCrossRefGoogle Scholar
  22. Greenberg, R., et al. (1977). Evaluation of brain function in severe human head trauma with multimodality evoked potentials, part 2: Localization of brain dysfunction and correlations with post-traumatic neurological conditions. Journal of Neurosurgery, 47, 163–177.PubMedCrossRefGoogle Scholar
  23. Greenberg, R. P, Newlon, P. G., et al. (1981). Prognostic implications of early multimodality evoked potentials in severely head-injured patients. Journal of Neurosurgery, 55, 227–236.PubMedCrossRefGoogle Scholar
  24. Gupta, N. K., et al. (1986). Visual evoked response in head trauma: Pattern-shift stimulus. Neurology, 36, 578–581.PubMedCrossRefGoogle Scholar
  25. Hall, K., Cope, N., & Rappaport, M. (1985). Glasgow Outcome Scale and Disability Rating Scale: Comparative usefulness in following recovery in traumatic head injury. Archives of Physical Medicine & Rehabilitation, 66, 35–37.Google Scholar
  26. Han, J. S., Kaufman, B., et al. (1984). Head trauma evaluated by magnetic resonance and computed tomography: A comparison. Radiology, 150, 71–77.PubMedGoogle Scholar
  27. Hume, A. L., & Cant, B. R. (1981). Central somatosensory condition after head injury. Annals of Neurology, 10, 411–419.PubMedCrossRefGoogle Scholar
  28. Hume, A. L., Cant, M. P, & Shaw, M. A. (1979). Central somatosensory conduction time in comatose patients. Annals of Neurology, 5, 379–384.PubMedCrossRefGoogle Scholar
  29. Jennett, W. B., & Plum, F (1972). The persistent vegetative state: A syndrome in search of a name. Lancet, 1,734–737.PubMedCrossRefGoogle Scholar
  30. Jennett, B., & Bond, M. (1975). Assessment of outcome after severe brain damage. A practical scale. Lancet, 1, 480–484.PubMedCrossRefGoogle Scholar
  31. Jennett, B., & Teasdale, G. (1977). Aspects of coma after severe head injury. Lancet, 1, 878–881.PubMedCrossRefGoogle Scholar
  32. Jennett, B., Teasdale, G., Braakman, R., et al. (1976). Predicting outcome in individual patients after severe head injury. Lancet, 1, 1031–1034.PubMedCrossRefGoogle Scholar
  33. Jennett, B., Teasdale, G., Braakman, R., et al. (1979). Prognosis of patients with severe head injury. Neurosurgery, 4, 283–289.PubMedCrossRefGoogle Scholar
  34. Jennett, B., Teasdale, G., et al. (1987). Prognosis of patients with severe head injury. Neurosurgery, 40, 291–298.Google Scholar
  35. Kaga, K., Nagai, T., & Takamori, A. (1985). Auditory short, middle and long latency responses in acutely comatose patients. Laryngoscope, 95, 321–325.PubMedCrossRefGoogle Scholar
  36. Kalsbeck, W. D., McLaurin, R. I., et al. (1980). The national head and spinal cord injury survey: Major findings. Journal of Neurosurgery, 53(Suppl.), 19–31.Google Scholar
  37. Karnaze, D., et al (1982). Localizing and prognostic value of auditory evoked responses in coma after closed head injury. Neurology, 32, 299–302.PubMedCrossRefGoogle Scholar
  38. Karnaze, D., Winer, I., & Marshall, L. (1985). Auditory evoked potentials in coma after closed head injury: A clinical-neurophysiological coma scale for predicting outcome. Neurology, 35, 1122–11265.PubMedCrossRefGoogle Scholar
  39. Kindsay, K. W., et al. (1981). Evoked potentials in severe head injury—Analysis and relation to outcome. Journal of Neurology, Neurosurgery & Psychiatry, 44, 796–802.CrossRefGoogle Scholar
  40. Lange-Cossach, W., Riebel, W., & Gramme, T. (1981). Possibilities and limitation of rehabilitation after traumatic apallic syndrome in children and adolescents. Neuropediatrics, 12, 338–365.Google Scholar
  41. Levati, A., et al. (1982). Prognosis of severe head injuries. Journal of Neurosurgery, 57, 779–783.PubMedCrossRefGoogle Scholar
  42. Levy, D. E., Knill-Jones, R. P., & Plum, F. (1978). The vegetative state and its prognosis following non-traumatic coma. Annals of the New York Academy of Sciences, 315, 293–306.PubMedCrossRefGoogle Scholar
  43. Lokkeberg, A. R., & Grime, R. M. (1984). Assessing the influence of non-treatment variables in a study of outcome from severe head injury. Journal of Neurosurgery, 61, 254–262.PubMedCrossRefGoogle Scholar
  44. Lutschg, J., et al (1983). Brain-stem auditory evoked potentials and early somatosensory evoked potentials in neurointensively treated comatose children. American Journal of Disabled Children, 137, 421–426.Google Scholar
  45. Mahoney, W. J., D’Souza, B. J., & Freeman, J. M. (1981). Surprising good outcome of prolonged coma after severe head injury. Annals of Neurology, 10, 286.Google Scholar
  46. Mizrani, E. M., & Kellaway, P. (1984). Censoral concussion in children: Assessment of injury by electroencephalography. Pediatrics, 73, 419–425.Google Scholar
  47. Narayan, R., Greenberg, R., et al. (1981). Improved confidence of outcome prediction in severe head injury: A comparative analysis of the clinical examination, multimodality evoked potentials, CT scanning and intracranial pressure. Journal of Neurosurgery, 54, 751–762.PubMedCrossRefGoogle Scholar
  48. Newlon, P. G., & Greenberg, R. P. (1984). Evoked potentials in severe head injury. The Journal of Trauma, 24, 61–66.PubMedCrossRefGoogle Scholar
  49. Newlon, P. G., Greenberg, R. P., et al. (1982). The dynamics of neuronal dysfunction and recovery following severe head injury assessed with serial multimodality evoked potentials. Journal of Neurosurgery, 57, 168–177.PubMedCrossRefGoogle Scholar
  50. Papanicolaou, A., et al. (1984). Evoked potential correlates of post-trauma amnesia after closed head injury. Neurosurgery, 14, 676–678.PubMedCrossRefGoogle Scholar
  51. Papanicolaou, A., Loving, D., Eisenbert, H., Raz, N., & Contreras, F. (1986). Auditory brain stem evoked responses in comatose head-injured patients. Neurosurgery, 18, 173–175.PubMedCrossRefGoogle Scholar
  52. Pfurtscheller, G., et al. (1985). Clinical relevance of long-latency SEPs and VEPs during coma and emergence from coma. Electroencephalography & Clinical Neurophysiology, 62, 88–98.CrossRefGoogle Scholar
  53. Plum, F., & Posner, J. B.(1980). The diagnosis of stupor and coma (3rd ed.). Philadelphia: Davis.Google Scholar
  54. Rosenberg, C., Wogensen, K., & Starr, A. (1984). Auditory brain-stem and middle and long-latency evoked potentials and coma. Archives of Neurology, 41, 835–838.PubMedCrossRefGoogle Scholar
  55. Rosenblum, W. I., et al (1981). Midbrain lesions: Frequent and significant prognostic feature in closed head injury. Neurosurgery, 9, 613–620.PubMedCrossRefGoogle Scholar
  56. Rumpl, E., Prugger, M., et al. (1983). Central somatosensory conduction time and short latency somatosensory evoked potentials in post-traumatic coma. Electroencephalography & Clinical Neurophysiology, 56, 583–596.CrossRefGoogle Scholar
  57. Scherg, M., Cramon, D., & Elton, M. (1984). Brain-stem auditory evoked potentials in post-comatose patients after severe closed head trauma. Journal of Neurology, 231, 1–5.PubMedCrossRefGoogle Scholar
  58. Shaw, N. A., & Cant, B. R. (1984). The effect of experimental concussion on somatosensory evoked potentials. Australian Journal of Experimental Biology & Medical Science, 62, 361–371.CrossRefGoogle Scholar
  59. Stablein, D. N., et al. (1980). Statistical methods for determining prognosis in severe head injury. Neurosurgery, 6, 243–248.PubMedCrossRefGoogle Scholar
  60. Stone, J. L., Ghaly, R. F., & Hughes, J. R. (1988). Electroencephalography in acute head injury. Journal of Clinical Neurophysiology, 5, 125–133.PubMedCrossRefGoogle Scholar
  61. Stone, J. L., Ghaly, R. F., & Hughes, J. R. (1988). Evoked potentials in head injury and states of increased intracranial pressure. Journal of Clinical Neurophysiology, 5, 135–160.PubMedCrossRefGoogle Scholar
  62. Synek, V. M. (1988). Prognostically important EEG coma patterns in diffuse anoxic and traumatic encephalopathies in adults. Journal of Clinical Neurophysiology, 5, 161–174.PubMedCrossRefGoogle Scholar
  63. Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. Lancet, 2, 81–84.PubMedCrossRefGoogle Scholar
  64. Walser, H., Emre, M., & Janzer, R. (1986). Somatosensory evoked potentials in comatose patients: Correlation with outcome and neuropathological findings. Journal of Neurology, 233, 34–40.PubMedCrossRefGoogle Scholar
  65. Ward, J. D., & Alberico, A. M. (1987). Pediatric head injury. Brain Injury, 1, 21–25.PubMedCrossRefGoogle Scholar
  66. Williams, D., & Denny-Brown, D. (1941). Cerebral electrical changes in experimental concussion. Brain, 64, 223–238.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1992

Authors and Affiliations

  • Donald A. Taylor
    • 1
  1. 1.Cumberland HospitalNew KentUSA

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