Predicting the outcome for individual patients with traumatic brain injury: a case-based review

Abstract

Background Traumatic brain injuries result in significant morbidity and mortality. Accurate prediction of prognosis is desirable to inform treatment decisions and counsel family members. Objective To review the currently available prognostic tools for use in traumatic brain injury (TBI), to analyse their value in individual patient management and to appraise ongoing research on prognostic modelling. Methods and results We present two patients who sustained a TBI in 2011–2012 and evaluate whether prognostic models could accurately predict their outcome. The methodology and validity of current prognostic models are analysed and current research that might contribute to improved individual patient prognostication is evaluated. Conclusion Predicting prognosis in the acute phase after TBI is complex and existing prognostic models are not suitable for use at the individual patient level. Data derived from these models should only be used as an adjunct to clinical judgement and should not be used to set limits for acute care interventions. Information from neuroimaging, physiological monitoring and analysis of biomarkers or genetic polymorphisms may be used in the future to improve accuracy of individual patient prognostication. Clinicians should consider offering full supportive treatment to patients in the early phase after injury whilst the outcome is unclear.

Keywords:

• Head injury
• neurosurgical intensive care
• outcome
• prognosis
• TBI

Disclosure statement

E.L.C. received salary support from an FP7 grant from the European Commission (TBIcare). D.K.M. is supported by the NIHR Cambridge Biomedical Centre and by an NIHR Senior Investigator Award, and by an FP7 grant from the European Commission (TBIcare). P.J.A.H. is supported by the NIHR Cambridge Biomedical Research Centre and by an NIHR Research Professorship. He has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative. A.G.K. is supported by a Royal College of Surgeons of England Research Fellowship (funded by the Freemasons and the Rosetrees Trust), an NIHR Academic Clinical Fellowship and a Raymond and Beverly Sackler Studentship.