Long-term prognosis for patients with severe brain damage is better than expected

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The new study adds a body of evidence that decisions to discontinue life-sustaining therapy in patients with moderate to severe head injury (TBI) should not be made soon after injury. I go.

July 6, 2021 JAMA Neurology, University of California, San Francisco, Wisconsin Medical College and Spalding Rehabilitation Hospital followed 484 researchers patient With moderate to severe TBI. They are, Installation status, 1 in 4 “got back on the road”, meaning that in 12 months they knew who they were, where they were and when. Injury..

Jeffrey Manly, MD, professor and vice president of neurosurgery at the University of California at San Francisco, said: A neurosurgery study at Zuckerberg San Francisco General Hospital noted that 64 of the 92 deaths in this study occurred in two weeks after the injury.

“TBI is a life changing event that can lead to severe and permanent disability, and it can be very obvious early on that the patient will not recover from it,” he said. “But the results of this study show that a significant proportion of participants experienced significant improvements in vital function and that many regained their independence within 2 weeks to 12 months after the injury. “

Patients in this study were recruited by the Brain Injury Research Initiative TRACK-TBI, of which Manly is the principal investigator. All patients were 17 years of age or older and were admitted to a hospital with a level 1 trauma center within 24 hours of injury. Their trial met the criteria for moderate TBI (about a third of patients) or severe TBI.

In both groups, the most common causes of injury were falls, assaults, and primarily car-motorcycle collisions, with patients being drivers / passengers, pedestrians, or cyclists.

Patients aged 35 (78% males) in the severe TBI group and 38 (80% males) in the moderate TBI group were assessed using the Glassgow Outcomes Scale Extended (GOSE) . 8. For a “good recovery” and the resumption of a normal life. The Disability Rating Scale (DRS) was also used to classify disabilities.

At 12 months, a small but significant minority of severe TBI patients were not affected.

According to the DRS, two weeks after the injury, 93% of the severe TBI group and 79% of the moderate TBI group had moderate to severe disability, with a GOSE score of 2 to 3 in 80%. In other words, we needed help. With basic daily functions.

However, at 12 months, half of the severe TBI group and three-quarters of the moderate TBI group had a GOSE score of at least 4, indicating that they could function independently at home for at least 8 hours per day. .. Additionally, according to the DRS, the researchers claim that 19% of the severe TBI group had no disabilities and 14% had only minor injuries.

The most surprising results were the results of 62 surviving patients with persistent vegetative disorder. It is defined as a condition of chronic brain dysfunction in which a person shows no signs of consciousness. All the patients regained consciousness at 12 months and 14 of 56 (1 of 4) with the available data resumed their orientation. All survivors except one in this group have at least regained basic communication skills.

Dr Joseph Jacino, co-lead author of Massachusetts General Hospital and Spaulding Rehabilitation Hospital at Harvard Medical School, said, “They had a GOSE score of 4 or higher, which meant they were able to respond to questions. basic needs such as food and toilets, so they can stay home unattended for at least eight hours a day.

This study follows previous studies showing that a significant proportion of patients with severe disabilities achieve favorable function after months or years. The study, led by Gacino, was in line with the American Academy of Neurology’s 2018 recommendation that the first 28 days after injury should refrain from telling families that the patient’s prognosis is beyond everything. hope.

“Although a significant proportion of patients die or have permanent disability, our study increases the evidence that severe acute disability is not a precursor of consistently poor long-term outcomes. “” said Manly, who also belongs to the UCSF Weil Institute for Neuroscience. “Even in patients with persistent vegetative disorder, this is a dynamic condition that progresses during the first year and can be seen as dire and improving.”

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For more information:
JAMA Neurology (2021). DOI: 10.1001 / jamaneurol.2021.2043

Quote: Study: Long-term prognosis for selected patients with severe brain injury better than expected (July 20, 2021), https: //medicalxpress.com/news/2021-07-long-term-prognosis- Obtained from patients- 20 July 2021 Severe-brain.html

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Long-term prognosis for patients with severe brain damage is better than expected

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