Prognostication and Determinants of Outcome in Adults and Children with Moderate-to-Severe Traumatic Brain Injury

Abstract

It has been suggested in the literature that many physicians lack comfort in assessing prognosis following traumatic brain injury (TBI). The purpose of this review is to investigate the most recent work on predicting outcomes after moderate-to-severe TBI. TBI is one of the leading causes of disability in the USA with an estimated 13.5 million individuals affected by varying severities of TBI. Many clinical variables, including age, admission Glasgow Coma Scale score, duration of posttraumatic amnesia, and duration of coma, have been studied to determine whether they play a role in outcome prediction. Newer variables being studied include serum biomarkers, abnormalities observed on magnetic resonance imaging, and data obtained from evoked potentials. The role of physiatry in evaluating patients following moderate-to-severe TBI is a valuable but difficult proposition. Appropriate distribution of acute treatment and rehabilitation resources is of utmost importance. For prognostication to be clinically useful, physiatrists must provide a reasonable impression of what life will be like for the patient in the longer term. In the future, additional work will be needed to better combine predictor variables tailored with precision to the patient to provide a clearer picture of individual outcomes following moderate-to-severe TBI.