injuries poisoning
Traumatic Brain Injury (TBI)
Prognosis for Traumatic Brain Injury
In the United States, adults with severe traumatic brain injury (TBI) who are treated have a mortality rate of about 25 to 33%. Mortality is lower when Glasgow Coma Scale (GCS) scores are higher. Mortality rates are lower in children≥5 years (≤10% in those with a GCS score of 5 to 7). Children overall do better than adults with a comparable injury. The vast majority of patients with mild TBI retain good neurologic function. With moderate or severe TBI, the prognosis is not as good but is much better than is generally believed. The most commonly used scale to assess outcome in TBI patients is the Glasgow Outcome Scale. On this scale, the possible outcomes are Good recovery (return to previous level of function) Moderate disability (capable of self-care) Severe disability (incapable of self-care) Vegetative (no cognitive function) Death Other prognostic grading systems based on CT findings, such as the Marshall classification system and the more recently developed Rotterdam CT score, can also be used to estimate long-term survival ( Prognosis references ). Over 50% of adults with severe TBI have a good recovery or only moderate disability. Occurrence and duration of coma after a TBI are strong predictors of disability. Of patients whose coma exceeds 24 hours, 50% have severe persistent neurologic sequelae, and up to 6% remain in a persistent vegetative state at 6 months. In adults with severe TBI, recovery occurs most rapidly within the initial 6 months. Smaller improvements continue for perhaps as long as several years. Children have a better immediate recovery from TBI regardless of severity and continue to improve for a longer period of time. Cognitive deficits, with impaired concentration, attention, and memory, and various personality changes are a more common cause of disability in social relations and employment than are focal motor or sensory impairments. Posttraumatic anosmia and acute traumatic blindness seldom resolve after 3 to 4 months. Hemiparesis and aphasia usually resolve at least partially, except in older patients. 1.Maas AI, Hukkelhoven CW, Marshall LF, et al: Prediction of outcome in traumatic brain injury with computed tomographic characteristics: A comparison between the computed tomographic classification and combinations of computed tomographic predictors.Neurosurgery57(6):1173–1182, 2005. doi: 10.1227/01.neu.0000186013.63046.6b 2.Charry JD, Falla JD, Ochoa JD, et al: External validation of the Rotterdam computed tomography score in the prediction of mortality in severe traumatic brain injury.J Neurosci Rural Pract8(Suppl 1):S23–S26, 2017. doi: 10.4103/jnrp.jnrp_434_16 