Abstract 226: Long-term Trajectory Of Neurologic Outcome After Severe Traumatic Brain Injury

Abstract

Objective : Little is known about the time-based trajectories of neurologic recovery after traumatic brain injury (TBI). We sought to determine long-term changes in neurologic status after TBI. Methods: Data source: Resuscitation Outcomes Consortium Hypertonic Saline TBI Trial. Included: adult TBI, GCS≤8; Excluded: shock (SBP≤70, or SBP 71-90 with HR≥108). Primary outcome: Glasgow Outcome Scale-Extended (GOS-E; 1=dead, 8=no disability) determined at: a) hospital discharge and b) 6-months. We analyzed changes in GOS-E between hospital discharge and 6-months using Sankey graphs and the Wilcoxon signed-rank test. We repeated the analysis for the high acuity subset of patients undergoing EMS advanced airway insertion. Results: Among 1,282 TBI, GOS-E at discharge was: dead (GOS-E 1) n=321 (25.0%), unfavorable (2-4) n=664 (51.8%), favorable (5-8) n=220 (17.2%), missing n=77 (6.0%; Figure). GOS-E at 6-months was: dead n=346 (27.0%), unfavorable n=282 (22.0%), favorable n=459 (35.8%), missing n=195 (15.2%). While 7 of 220 (3.2%) with favorable GOS-E at discharge worsened at 6 months (unfavorable or died), 300 of 664 (45.2%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p<0.0001). In the EMS advanced airway subset (n=774), 2 of 96 (7.1%) with favorable GOS-E at discharge worsened to unfavorable (or were dead) at 6 months, while 208 of 433 (48.0%) with unfavorable GOS-E improved to favorable at 6 months (Wilcoxon signed-rank for GOS-E change p<0.0001). Conclusion: Among patients with TBI and unfavorable neurologic status at hospital discharge, almost half will progress to favorable neurologic status at 6 months. Very few TBI victims die or worsen to unfavorable neurologic status by the time of 6-month follow-up. Thus, assessment of long-term neurologic outcome should be considered for studies of TBI.