Managing outcome expectations after traumatic brain injury

Citation

Maas AIR, Hemphill JC, Wilson L & Manley GT (2023) Managing outcome expectations after traumatic brain injury. Injury, 54 (5), pp. 1233-1235. https://doi.org/10.1016/j.injury.2023.03.027

Abstract
Traumatic brain Injury (TBI) has the highest incidence of all common neurological disorders, and poses a substantial public health burden, costing the global economy approximately US $400 billion per year [1]. One of every 2 people on earth will suffer a TBI during their lifetime, and for many this will result in long-term sequelae or lifelong disability. TBI is now appreciated as a chronic disease, not simply an acute condition, carrying increased risk of later neurodegeneration. Knowledge of acute and long-term outcomes is essential to deliver appropriate care and to assess its efficacy. Yet, few intensive care physicians follow-up patients after discharge from the ICU, and follow-up of patients with milder forms of injury is particularly deficient. The ancient Hippocratic aphorism, “No head injury is so serious that it should be despaired of nor so trivial that it can be ignored” holds to this day. In current clinical practice this time-honored wisdom is often neglected, as expectations of outcome, often not evidence-based, influence treatment decisions. Such expectations may be unnecessarily pessimistic or unduly optimistic, and over-confidently maintained. In this Editorial, we discuss approaches to outcome assessment and prognostic estimates after TBI, and highlight the risks of unnecessarily pessimistic or unduly optimistic expectations.

Keywords
Traumatic brain injury; Outcome; Prognosis; Withdrawal of life-sustaining treatment

Notes
1879-0267 Maas, Andrew I R Hemphill, J Claude Wilson, Lindsay Manley, Geoffrey T Editorial Netherlands Injury. 2023 May;54(5):1233-1235. doi: 10.1016/j.injury.2023.03.027.

Journal
Injury: Volume 54, Issue 5