Long-term Benefits for Younger Patients with Aggressive Immediate Intervention Following Severe Traumatic Brain Injury: A Longitudinal Cohort Analysis of 175 Patients from a Prospective Registry

Introduction: The prevalence of traumatic brain injury (TBI) continues to rise, in part as a reflection of a growing elderly population. Concomitantly, nihilism may exist following substantial neurotrauma from a myriad of commonplace mechanisms such as traffic incidents, assaults, or falls. This study assesses long-term outcomes following aggressive surgical intervention with invasive neuromonitoring to guard against nihilism, especially for patients with advantageous characteristics such as younger age.

Methods: A consecutive series of severe TBI patients treated between 2008 and 2018 and enrolled into the Brain Trauma Research Center (BTRC) database, an Institutional Review Board (IRB 19030228) approved prospective, longitudinal cohort study, were extracted. Demographic, clinical, and imaging data were analyzed. Long-term functional outcome was recorded with the eight-point Glasgow Outcome Scale-Extended (GOS-E) scale at 3-, 6-, 12-, and 24-months by trained, qualified neuropsychology technicians. Chi-square test and analysis of variance test were used to evaluate the relationship of age groups between different variables.

Results: For this analysis, 175 severe TBI patients who were enrolled in the BTRC database and required decompressive hemicraniectomy during the study period were included. Of patients less than 35 years old with a severe TBI at 24 months, over one-third had a favorable outcome.

Conclusion : Despite severe TBIs, a substantial percentage of younger patients did achieve favorable outcomes following aggressive treatment. As such, establishing a prognosis should be deferred to allow for recovery via individualized rehabilitation, multidisciplinary support, and community reintegration programs to cope with various long-term psychological, cognitive, and functional disabilities.