Ansari Ali, Zoghi Sina, Tavanaei Roozbeh, Payman Andre A, Lu Victor M, Niakan Amin, Taheri Reza, Khalili Hosseinali
Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
Neurosurg Rev. 2025 Jan 13;48(1):41. doi: 10.1007/s10143-024-03163-9.
Traumatic Brain Injury (TBI) is a devastating cause of death and disability. Outcomes following TBI have been extensively studied; however, less attention has been given to identifying characteristics of individuals who have a favorable outcome following severe TBI. We conducted a retrospective analysis of a database containing information on TBI patients admitted to a level 1 trauma center between 2015 and 2021. We focused on patients who were initially admitted with severe TBI (GCS 8 or lower), and had a final favorable functional outcome (GOSE 5 or higher), at six months. Our investigation aimed to identify factors associated with early in-hospital recovery versus delayed post-discharge recovery, as well as factors associated with moderate disability versus good recovery in six-month follow-up, the time that all investigated patients had achieved a favorable outcome. A total of 513 patients were included in the study. Of these, 67.2% achieved early in-hospital recovery, while 32.8% experienced delayed post-discharge recovery. Features such as anisocoric or fixed pupillary light reflex, subarachnoid hemorrhage, intraventricular hemorrhage and, the need for decompressive craniectomy, and tracheostomy were independently associated with delayed recovery in severe TBI patients. Among the 513 patients, 105 (20.4%) had moderate disability, while 408 (79.6%) were in good recovery at the six-month follow-up. Midline shift greater than 5 mm and the need for tracheostomy were independently associated with moderate disability. Our study offers insights into characteristics of severe TBI patients with a favorable outcome at six months. Our results suggest that it may be premature to predict a poor prognosis for patients with severe TBI who do not show early improvement after their injury. Interestingly, approximately one third of patients with a favorable six-month outcome fell into this category.
创伤性脑损伤（TBI）是导致死亡和残疾的一个毁灭性原因。TBI后的预后情况已得到广泛研究；然而，对于识别重度TBI后预后良好的个体特征却较少受到关注。我们对一个数据库进行了回顾性分析，该数据库包含了2015年至2021年间入住一级创伤中心的TBI患者的信息。我们重点关注那些最初因重度TBI（格拉斯哥昏迷量表[GCS]评分为8分或更低）入院，且在6个月时最终功能预后良好（扩展格拉斯哥预后量表[GOSE]评分为5分或更高）的患者。我们的研究旨在确定与早期院内恢复和出院后延迟恢复相关的因素，以及在6个月随访中与中度残疾和良好恢复相关的因素，6个月是所有被调查患者均达到良好预后的时间点。该研究共纳入了513例患者。其中，67.2%的患者实现了早期院内恢复，而32.8%的患者经历了出院后延迟恢复。诸如瞳孔不等大或固定瞳孔对光反射、蛛网膜下腔出血、脑室内出血以及需要进行减压颅骨切除术和气管切开术等特征，与重度TBI患者的延迟恢复独立相关。在这513例患者中，105例（20.4%）有中度残疾，而408例（79.6%）在6个月随访时恢复良好。中线移位大于5毫米和需要进行气管切开术与中度残疾独立相关。我们的研究为6个月时预后良好的重度TBI患者的特征提供了见解。我们的结果表明，对于受伤后未早期改善的重度TBI患者预测其预后不良可能为时过早。有趣的是，约三分之一6个月预后良好的患者属于这一类别。
