One-year outcome and course of recovery after severe traumatic brain injury

To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma.

Between January 2001 and December 2005, 13 European centres enrolled 1,172 patients with severe TBI defined as Glasgow Coma Scale (GCS) score < 9. Demographic data, trauma severity, results of computed tomography (CT) scans, data on status, treatment and outcome were recorded. The five-level Glasgow Outcome Scale (GOS) score was used to classify patients as having a “favourable” (GOS scores 5 and 4) or an “unfavourable outcome” (GOS scores 3, 2 and 1).

Of the 1,172 patients, 37% died in the intensive care unit (ICU) and 8.5% died after ICU discharge. At 12 months after trauma, almost half of the outcomes (46.6%) were classified as “favourable” (33% “good recovery”, 13.6% “moderate disability”) and 7.9% were classified as “unfavourable” (6.1% “severe disability”, 1.8% “vegetative status”). As in previous studies, long-term outcomes were influenced by age, severity of trauma, first GCS score, pupillary status and CT findings (e.g. subdural haematoma and closed basal cistern on the first CT scan). Patients with “good recovery” had a high likelihood to remain in that category (91%). Patients with “moderate disability” had a 50% chance to improve to “good recovery”. Patients with “severe disability” had a 40% chance to improve and had a 4% chance of death. Patients with “vegetative status” were more likely to die (42%) than to improve (31%). Changes were more likely to occur during the first than during the second half-year after trauma.