Swarna Sujith, Saadon Jordan R, Robertson Jermaine, Vagal Vaibhav, Cleri Nathaniel A, Butler Kurt, Cheng Xi, Hua Yindong, Aghili Seyed Morsal Mosallami, Uwakwe Chiemeka, Zhang Jason, Zheng Xuwen, Singh Aniket, Wang Cassie, Hagan Thomas, Huang Chuan, Djurić Petar M, Mikell Charles B, Mofakham Sima
Department of Neurosurgery, Renaissance School of Medicine at Stony, Brook University, Stony Brook, NY, USA.
Department of Neurosurgery, University of Maryland Medical Center, Baltimore, MD, USA.
Neurocrit Care. 2025 Jun 27. doi: 10.1007/s12028-025-02304-2.
Consciousness recovery after severe traumatic brain injury (sTBI) can take minutes to years. Despite this variability, we hypothesized that we could identify subgroups with distinct temporal recovery trajectories and that these subgroups would have distinct clinical features.
We conducted a retrospective cohort study to analyze recovery trajectories for patients with sTBI (Glasgow Coma Scale [GCS] score ≤ 8) admitted to Stony Brook University Hospital from 2010 to 2019. Patients meeting our criteria for recovery (GCS score ≥ 13) were classified into cohorts using the slopes of their recovery trajectories. We then characterized these groups by their clinical features, neuroimaging, and electroencephalography (EEG).
A total of 501 patients with sTBI (348 men, mean age 51 years) were included in this study. Of these, 299 recovered. After analyzing their recovery rates, two distinct groups emerged, (1) fast recovery (n = 215) and (2) slow recovery (n = 84), with a median recovery time of 6 (interquartile range [IQR] 2-12) vs. 33 (IQR 27-44.75) days. Slow recovery patients had higher Injury Severity Scores (median 30 [IQR 25-41.75] vs. 24 [IQR 16-30]; 95% confidence interval [CI] 4.4495-10.6105; P < 0.001), more thalamic injury on neuroimaging (normalized volume [voxels] - 0.664 vs. 1.74; R = 0.781; P < 0.016), and impaired interhemispheric connectivity on EEG (phase-locking value 0.35 vs. 0.44; 95% CI 0.055-0.14; P < 0.001).
Recovery after sTBI falls into two broad categories, distinguishable by injury severity, thalamic injury, and disrupted interhemispheric connectivity. This model accounts for heterogeneity in TBI outcomes and represents progress toward identifying targets for future neuromodulatory therapeutic development.
重度创伤性脑损伤（sTBI）后意识恢复可能需要数分钟至数年时间。尽管存在这种变异性，但我们假设可以识别出具有不同时间恢复轨迹的亚组，并且这些亚组将具有不同的临床特征。
我们进行了一项回顾性队列研究，以分析2010年至2019年入住石溪大学医院的sTBI患者（格拉斯哥昏迷量表[GCS]评分≤8）的恢复轨迹。符合我们恢复标准（GCS评分≥13）的患者根据其恢复轨迹的斜率分为不同队列。然后，我们通过他们的临床特征、神经影像学和脑电图（EEG）对这些组进行了特征描述。
本研究共纳入501例sTBI患者（348例男性，平均年龄51岁）。其中，299例恢复。在分析他们的恢复率后，出现了两个不同的组，（1）快速恢复组（n = 215）和（2）缓慢恢复组（n = 84），中位恢复时间分别为6天（四分位间距[IQR] 2 - 12）和33天（IQR 27 - 44.75）。缓慢恢复的患者损伤严重程度评分更高（中位数30 [IQR 25 - 41.75] 对比24 [IQR 16 - 30]；95%置信区间[CI] 4.4495 - 10.6105；P < 0.001），神经影像学上丘脑损伤更多（标准化体积[体素] - 0.664对比1.74；R = 0.781；P < 0.016），脑电图上半球间连接受损（锁相值0.35对比0.44；95% CI 0.055 - 0.14；P < 0.001）。
sTBI后的恢复分为两大类，可通过损伤严重程度、丘脑损伤和半球间连接中断来区分。该模型解释了TBI结果的异质性，并代表了在确定未来神经调节治疗发展靶点方面的进展。
