@article{ref1,
title="Recovery trajectories and long-term outcomes in traumatic brain injury: a secondary analysis of the phase 3 COBRIT clinical trial",
journal="World neurosurgery",
year="2019",
author="Puffer, Ross C. and Yue, John K. and Mesley, Matthew and Billigen, Julia B. and Sharpless, Jane and Fetzick, Anita L. and Puccio, Ava M. and Diaz-Arrastia, Ramon and Okonkwo, David O.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="INTRODUCTION: Prospects for recovery after traumatic brain injury (TBI) are often underestimated, potentially leading to withdrawal of care in the comatose TBI patient who may ultimately have a favorable outcome with aggressive care. Outcomes and trajectories of recovery in a large series of TBI patients were evaluated at 30, 90 and 180 days post-injury. <br><br>METHODS: A secondary analysis of the Phase 3 COBRIT was performed analyzing recovery trajectories and long-term outcomes at 30, 90 and 180 days post-injury. A GOS-E of 5 or greater was considered favorable. Pearson Chi squared analysis was utilized and a p-value of 0.05 was considered significant. A locally weighted, polynomial regression model was used to model recovery trajectories in a non-linear fashion. <br><br>RESULTS: TBI subjects in the COBRIT trial had high rates of favorable outcome (57% of severe TBI, 86% of moderate TBI and 93% of complicated mild TBI) at 6 month follow-up. These favorable outcomes often converted from high rates of unfavorable outcome at initial 1 month follow-up (85% of severe TBI, 57% of moderate TBI and 21% of complicated mild TBI). Recovery trajectories had not plateaued at 6-months, suggesting that further improvement occurs beyond 6-months post-injury. <br><br>DISCUSSION: In this secondary analysis of the COBRIT trial, the majority of patients had favorable outcomes by GOS-E at 6-months post-injury in all complicated mild and moderate TBI groups, with over half of severe TBI patients achieving a favorable outcome as well. Of subjects in a vegetative state (GOS-E 2) at 1-month post-injury, 18% improved to a favorable outcome by 6-months post-injury. There was substantial improvement in all groups from 1-month to 6-months, and this improvement may continue beyond 6-months. Clinical trials in TBI should consider recovery curves with repeated measures to assess outcomes, as arbitrary single-moment outcome determination likely underestimates treatment effect in TBI care.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="1878-8750",
doi="10.1016/j.wneu.2019.01.207",
url="http://dx.doi.org/10.1016/j.wneu.2019.01.207"
}