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Clinical Elements that Predict Outcome after Traumatic Brain Injury

A Prospective Multicenter Recursive Partitioning (Decision –Tree) Analysis

Categories: Outcomes

The Question

What clinical elements associated with moderate to severe traumatic brain injury (TBI) predict outcome?

Past Studies

Past Studies investigating outcome prediction after TBI have used acute physiological variables (such as intracranial pressure and blood gas measurements) and gross clinical measures (such as pupil responses and abnormal motor patterns) after severe injury to predict survival and basic functional levels. The literature lacks studies that consider detailed post-acute physical examination information and multiple measures of injury severity to see which are important in predicting functional outcome in the long term. 

This Study

This Study used a large national databank from the Traumatic Brain Injury Model Systems (TBIMS) to consider what clinical elements predict disability at inpatient rehabilitation dismissal and at one year after injury, and what elements predict the need for supervision and productive activity at one year. The cumulative Traumatic Brain Injury Model Systems (TBIMS) national databank (1988-2002) included 3,463 individuals with TBI who received inpatient rehabilitation immediately after acute care in one of the TBIMS facilities. A statistical technique called recursive partitioning was used to determine which clinical elements (the physical examination as present on inpatient rehabilitation admission, Glasgow Coma Scale score, duration of post-traumatic amnesia, length of coma, cranial CT scan pathology, gender, age, and years of education) predict the outcomes (the Functional Independence Measure, Disability Rating Scale, the need for supervision as measured by the Supervision Rating Scale, and a measure of productive activity). The duration of post-traumatic amnesia, age, and most elements of the physical examination werepredictive of disability at inpatient rehabilitation dismissal. Only the duration of post-traumatic amnesia was selected to predict late disability and independent living needs one year after injury. The duration of post-traumatic amnesia, age, sitting balance, and limb strength predicted productive activity at one year. 

Who May Be Affected By These Findings

Persons with brain injury and their families, caregivers, community providers, health professionals and researchers.

Caveats

Duration of post-traumatic amnesia and the physical examination were the clinical elements most predictive of outcomes in this analysis. Precisely measuring these elements is likely to make outcome prediction more accurate. These results support the development and refinement of their measurement.

Bottom Line

The duration of post-traumatic amnesia is the most powerful predictor of function, independent living, and productive activity after TBI in the TBIMS database when analyzed with recursive partitioning. Age and most elements of the physical examination contributed to outcome prediction. The Glasgow Coma Scale score, cranial CT scan variables, and gender did not contribute to outcome prediction in this analysis.

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Find This Study

Brown, A.W., Malec, J.F., McClelland, R.L., Diehl, N.N., Englander, J., Cifu, D.W. (2005). Clinical Elements that Predict Outcome after Traumatic Brain Injury: A Prospective Multicenter Recursive Partitioning (Decision-Tree) Analysis. Journal of Neurotrauma, 22; 1040-1051.

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