Long-Term Functional Recovery after Severe Traumatic Brain Injury with Type II Diffuse Injury

Introduction: Severe Traumatic Brain Injury (sTBI) is a significant health and social burden, especially in low- and middle-income countries (LMIC). However, there is still a lack of studies on the long-term outcomes of sTBI in these regions. Therefore, this study aims to describe late clinical outcomes of sTBI patients from a middle-income country and its potential predictors.

Methods: Subjects 16-65 years of age with Glasgow Coma Scale ≤ 8, blunt TBI, and Marshall CT diffuse injury type II on admission were included. Exclusion criteria were death at discharge, previous TBI, and disabling neurological disease. Clinical, laboratory, and radiological data from admission were assessed. The primary outcome was the Glasgow Outcome Scale Extended (GOSE) at follow-up. Functional Independence Measure (FIM) and Zarit Burden Interview (ZBI) were also assessed.

Results: Sixty-five patients were included, with a median follow-up time of 8 years. Thirty-six (53.8%) patients died during the study period, 19 (29.2%) had good recovery (GOSE 7-8) and 10 (15.3%) had moderate-severe sequelae (GOSE 4-6). Among the potential predictors analyzed, only prothrombin time was associated with the primary outcome (p=0.01). The 6-month CRASH score was not associated with long-term outcomes (p=0.25). Out of 29 living patients, 9 had caregivers and 8 agreed to participate in the research, reporting a median ZBI score of 23.5 (range 5-48).

Conclusion : In this prospective cohort of more than 7 years, patients with sTBI demonstrated a high mortality rate, being coagulation impairment significantly associated with worse outcomes. Around ⅓ of sTBI patients were functionally dependent and unable to return to previous social and work activities. Current instruments used to predict outcomes of TBI patients have a poor correlation with late clinical outcomes in patients from LMIC, being new models needed to guide decision-making, resource allocation, and counseling.