TY  - JOUR
PY  - 2022//
TI  - Time to follow commands in severe traumatic brain injury survivors with favorable recovery at 2 years
JO  - Neurosurgery
A1  - Deng, Hansen
A1  - Nwachuku, Enyinna L.
A1  - Wilkins, Tiffany E.
A1  - Yue, John K.
A1  - Fetzick, Anita
A1  - Chang, Yue-Fang
A1  - Beers, Sue R.
A1  - Okonkwo, David O.
A1  - Puccio, Ava M.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - BACKGROUND: The recovery of severe traumatic brain injury (TBI) survivors with long-term favorable outlook is understudied. Time to follow commands varies widely in this patient population but has important clinical implications. <br><br>OBJECTIVE: To (1) evaluate time to follow commands in severe patients with TBI with favorable outcomes, (2) characterize their trajectory of recovery, and (3) identify predictors associated with delayed cognitive improvement. <br><br>METHODS: Participants were recruited prospectively at a Level I trauma center through the Brain Trauma Research Center from 2003 to 2018. Inclusion criteria were age 16 to 80 years, Glasgow Coma Scale score ≤8 and motor score <6, and Glasgow Outcome Scale-Extended measure ≥4 at 2 years postinjury. <br><br>RESULTS: In 580 patients, there were 229 (39.5%) deaths and 140 (24.1%) patients had favorable outcomes at 2 years. The mean age was 33.7 ± 14.5 years, median Glasgow Coma Scale was 7 (IQR 6-7), and median Injury Severity Score was 30 (IQR 26-38). The mean time to follow commands was 12.7 ± 11.8 days. On multivariable linear regression, the presence of diffuse axonal injury (B = 9.2 days [4.8, 13.7], P <.0001) or intraventricular hemorrhage (B = 6.4 days [0.5, 12.3], P <.035) was associated with longer time before following commands and patients who developed nosocomial infections (B = 6.5 days [1.6-11.4], P <.01). <br><br>CONCLUSION: In severe TBI survivors with favorable outcomes, time to follow commands varied widely. Most patients began to follow commands within 2 weeks. Evidence of diffuse axonal injury, intraventricular hemorrhage, and infections can delay cognitive improvement in the acute period. Patients make considerable recovery up to 2 years after their injury.<p />  <p>Language: en</p>
LA  - en
SN  - 0148-396X
UR  - http://dx.doi.org/10.1227/neu.0000000000002087
ID  - ref1
ER  -