Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
World Neurosurg. 2024 Sep;189:e580-e590. doi: 10.1016/j.wneu.2024.06.116. Epub 2024 Jun 25.
Traumatic brain injury (TBI) is a major cause of physical disabilities worldwide. Herein, we aimed to investigate the factors contributing to post-discharge recovery in patients who were discharged with an unfavorable outcome.
We collected data on the characteristics of patients, with a focus on those who survived TBI but had an unfavorable outcome at discharge as measured by Glasgow Outcome Scale Extended (GOSE) categories 2, 3, and 4. Post-discharge recovery was defined as achieving a favorable functional status at 6 months (GOSE of 5 or more) with a minimum 2-point increase in GOSE.
Of 4011 TBI patients in our registry, 797 had an unfavorable discharge functional status. In severe TBI, 51% achieved recovery, while in mild to moderate TBI, 57% achieved recovery after 6 months. Older patients and those with shorter intensive care unit length of stay were more likely to experience post-discharge recovery in both mild to moderate and severe TBI groups. The presence of skull base fracture was also associated with post-discharge recovery in severe TBI patients. Lastly, we show that, after adjustment for potential confounders, GOSE at discharge is associated with post-discharge recovery in both mild to moderate and severe TBI patients.
This study found that the majority of patients discharged with an unfavorable functional status were able to achieve a favorable outcome within 6 months. The novel post-discharge recovery in TBI patients might be a useful tool for illuminating the factors associated with a significant improvement after discharge.
创伤性脑损伤（TBI）是全球范围内导致身体残疾的主要原因。在此，我们旨在研究导致出院后预后不良的患者在出院后恢复的因素。
我们收集了患者特征的数据，重点是那些存活但出院时格拉斯哥结局量表扩展（GOSE）分类为 2、3 和 4 的预后不良的患者。出院后恢复定义为在 6 个月时达到良好的功能状态（GOSE 为 5 或更高），GOSE 至少增加 2 分。
在我们的登记处的 4011 例 TBI 患者中，有 797 例出院时功能状态不佳。在严重 TBI 中，51%的患者恢复，而在轻度至中度 TBI 中，57%的患者在 6 个月后恢复。在轻度至中度和严重 TBI 组中，年龄较大的患者和 ICU 住院时间较短的患者更有可能在出院后恢复。颅底骨折的存在也与严重 TBI 患者的出院后恢复有关。最后，我们表明，在调整潜在混杂因素后，出院时的 GOSE 与轻度至中度和严重 TBI 患者的出院后恢复相关。
本研究发现，大多数出院时功能状态不佳的患者能够在 6 个月内达到良好的结局。TBI 患者的这种新的出院后恢复可能是一个有用的工具，可以阐明出院后显著改善相关的因素。
