Changes in Outcomes after Discharge from an Acute Hospital in Severe Traumatic Brain Injury

• Published in: Neurologia medico-chirurgica Vol. 62; no. 3; pp. 111 - 117
• Main Authors: HAJI, Kohei, The Japan Neurotrauma Data Bank Committee, SUZUKI, Michiyasu, KIYOHIRA, Miwa, SUEHIRO, Eiichi
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 01.01.2022; THE JAPAN NEUROSURGICAL SOCIETY; Japan Science and Technology Agency
• Subjects: biomarker; Brain Injuries; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnosis; Brain Injuries, Traumatic - therapy; Convulsions; discharge destination; Glasgow Outcome Scale; Hospitals; Humans; Multivariate analysis; Original; outcome improvement; Patient Discharge; Patients; rehabilitation; Traumatic brain injury; Treatment Outcome; traumatic brain injury; outcome improvement; rehabilitation; discharge destination; biomarker
• ISSN: 0470-8105; 1349-8029; 1349-8029
• DOI: 10.2176/nmc.oa.2021-0217

Neurological improvement occurs from the subacute to chronic phases in severe traumatic brain injury. We analyzed factors associated with improved neurological findings in the subacute phase, using data from the Japan Neurotrauma Data Bank (JNTDB). The subjects were 1345 patients registered in the JNTDB (Project 2015). Clinical improvement was evaluated by comparing the Glasgow Outcome Scale (GOS) at discharge and 6 months after injury. Of these patients, 157 with severe disability (SD) on the discharge GOS were examined to evaluate factors associated with neurological improvement in the subacute phase. Cases were defined as those with (group I) and without (group N) improvement: a change from SD at discharge to good recovery (GR) or moderate disability (MD) at 6 months after injury. Patient background, admission findings, treatment, and discharge destination were examined. In all patients, the favorable outcome (GR, MD) rate improved from 30.2% at discharge to 35.7% at 6 months after injury. Of SD cases at discharge, 44.6% had a favorable outcome at 6 months (group I). Patients in group I were significantly younger, and had a significantly lower D-dimer level in initial blood tests and a lower incidence of convulsions. In multivariate analysis, discharge to home was a significant factor associated with an improved outcome. Many SD cases at discharge ultimately showed neurological improvement, and the initial D-dimer level may be a predictor of such improvement. The environment after discharge from an acute care hospital may also contribute to an improved long-term prognosis.