Prognosis of six-month functioning after moderate to severe traumatic brain injury: a systematic review of prospective cohort studies.
OBJECTIVE
To systematically review which determinants, assessed within the first month after a moderate to severe traumatic brain injury, predict 6-month functional outcome.


METHODS
Databases were searched for relevant publications between 1995 and August 2008. Selection criteria were: prospective cohort studies; determinants associated with functional outcome 6 months after moderate to severe traumatic brain injury in adult patients; determinants assessed within the first month post-injury. Two reviewers independently performed the selection and quality assessment. A best- evidence synthesis was performed for prognostic factors assessed in 2 or more studies.


RESULTS
Twenty-eight studies were included, 27 of which were high quality. Most studies used the Glasgow Outcome Score at 6 months post-injury as outcome measure, sometimes in combination with other outcome measures. Strong evidence for predicting outcome at 6 months was found for the Glasgow Coma Scale (GCS), GCS admission, motor score, midline shift on computed tomography scan, subdural haematoma and pulsatility index. Strong evidence of no association was found for gender and intraventricular haemorrhage. For other determinants, inconclusive or no evidence was found.


CONCLUSIONS
GCS, GCS on admission, motor score, midline shift, subdural haematoma and pulsatility index predicted outcome 6 months after traumatic brain injury. Gender and intraventricular haemorrhage did not have predictive value.
Husson
Els C
EC
Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
Ribbers
Gerard M
GM
Willemse-van Son
Agnes H P
AH
Verhagen
Arianne P
AP
Stam
Henk J
HJ
D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D013997:Time Factors