title: Long-term neurological and neuropsychological outcome in patients with severe traumatic brain injury.
abstract: BACKGROUND
  Severe traumatic brain injury (TBI) remains a major cause of death and disability worldwide. The aim of the study was to evaluate predictors for neurological and neuropsychological long-term outcome in patients with severe TBI treated according to an intracranial pressure (ICP-) targeted therapy.
  
  
  METHODS
  From 08/2005 to 12/2008, 46 patients with severe TBI and more than 12h of intensive care treatment were included in this study. Neurological outcome was assessed with the Glasgow Outcome Scale (GOS). Neuropsychological performance assessing 9 different domains was evaluated at long-term follow-up (median 20.5 months; range 10-46). Logistic regression was used to identify favourable outcomes according to the GOS and Fisher's exact tests were used to identify predictors of severe neuropsychological impairments at follow-up.
  
  
  RESULTS
  Twenty-nine patients were available for neuropsychological assessment at long-term follow-up. Only 2 out of 29 patients presented normal or average neuropsychological findings throughout all 9 neuropsychological domains at long-term follow-up. The percentage of a favourable outcome (GOS 4-5) increased from 13.8% at hospital discharge to 75.8% at rehabilitation discharge to 79.3% at long-term follow-up, respectively. Age ≤40 was found to be a strong predictor of favourable outcome at follow-up (OR 5.95, 95% CI 1.41 25.00, p=0.015). The GOS at hospital discharge was not a predictor for severe impairments in any of the 9 different neuropsychological domains (all p-values were p>0.268). In contrast, the GOS at rehabilitation discharge was found to be a predictor of severe impairments at follow-up in all but one domain assessed (all p-values less than p<0.038).
  
  
  CONCLUSIONS
  The GOS at rehabilitation discharge should be regarded as a better predictor for neuropsychological impairments at long-term follow-up than the GOS at hospital discharge. Even in patients with favourable GOS after finishing a course of rehabilitation, three quarters of these patients may have at least one severe neuropsychological deficit. Therefore, it remains of paramount importance to provide long-term neuropsychological support to further improve outcome after TBI.
authors.affiliation: Department of Neurosurgery, Kantonsspital, St.Gallen, Switzerland; Department of Neurosurgery and Faculty of Medicine, University Hospital, Geneva, Switzerland. Electronic address: oliver.gautschi@hcuge.ch.
authors.forename: Oliver P
authors.initials: OP
authors.lastname: Gautschi
authors.forename: Mélanie C
authors.initials: MC
authors.lastname: Huser
authors.forename: Nicolas R
authors.initials: NR
authors.lastname: Smoll
authors.forename: Sven
authors.initials: S
authors.lastname: Maedler
authors.forename: Stephan
authors.initials: S
authors.lastname: Bednarz
authors.forename: Alexander
authors.initials: A
authors.lastname: von Hessling
authors.forename: Roger
authors.initials: R
authors.lastname: Lussmann
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.forename: Martin A
authors.initials: MA
authors.lastname: Seule
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001288:Attention; D001930:Brain Injuries / Q000150:complications / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology*; D004651:Employment; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D023261:Glasgow Outcome Scale; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011597:Psychomotor Performance; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult
keywords: Glasgow Outcome Scale; ICP-targeted therapy; Long-term outcome; Neuropsychological outcome; Traumatic brain injury