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Neurosurgeons can Determine Long-Term Outcome for Three-Month Traumatic Brain Injury Survivors
SAN FRANCISCO (April 10, 2000)- Neurosurgeons can now determine patient rates of future recovery the three months following a traumatic brain injury, with an independent predictor scale. Brian R. Subach, MD, a neurosurgeon from Pittsburgh, and his colleagues, Donald W. Marion, MD, and Joseph T. King Jr., MD, will report on the findings of this study at the 68th Annual Scientific Meeting of the American Association of Neurological Surgeons on Tuesday, April 11.
The results of this study can affect many. Each year, an estimated one million people are treated and released from hospital emergency rooms due to traumatic brain injuries, according to the National Center for Disease Control and Prevention. Two-hundred thirty thousand people are hospitalized and survive, and an estimated 50,000 die. The risk of having a traumatic brain injury is especially high among adolescents, young adults and people older than 75 years of age.
The study found that the Glasgow Outcome Scale (GOS) is a powerful method of assessing long-term outcome for patients with severe traumatic brain injury during the first year post-injury. The scale quantifies the ability of the recovering patient to participate in normal everyday activities including dressing, eating and walking, and the degree to which the patient requires assistance. Only patients surviving at least three months after their injury were used in the study. Most of the patients were involved in motor vehicle accidents (78%), falls (16%) or were the victims of assault or industrial accidents (6%).
Between December 1990 and 1997, 159 patients with severe, closed traumatic brain injuries were treated at the University of Pittsburgh. Of those, 68 (43%) required emergency surgical procedures (defined as any intracranial surgical intervention that was performed within six hours of arrival at the hospital). In addition, all of the patients underwent craniotomy (surgical opening of the skull) for the removal of blood clots. The GOS at three months and 12 months were analyzed. The study consisted of primarily male patients (77%), with a median age of 30 years. Most changes evaluated again at 12 months were measured at higher levels of functioning.
Patients, who remained vegetative at 3 months, with a GOS of 2, were unlikely to show improvements. Nearly 68 percent of patients with a 3-month GOS of 3 (severely disabled requiring assistance with everyday activities) improved to a moderately disabled or good functional status at 12 months. A GOS of 4 or 5 was associated with at least a 95 percent chance of remaining at a functional level at the 12-month assessment. Higher levels of function were associated with degrees of independence.
"The power of this study is predictive," said Dr. Subach. "It gives physicians the opportunity to have serious discussions with families of brain injury victims regarding reasonable expectations for recovery of function."
The study revealed that patients sustaining traumatic brain injury do not have universally poor outcomes. The study is a critical tool for minimizing any stress to family members of these patients, as well as a mechanism of appropriately allocating health-care resources and accurately determining the patients' future functional status.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons is a scientific and educational association with nearly 5,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are Board-certified by the American Board of Neurological Surgery. Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves.
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Media Representatives: The Annual Meeting press kit can be found in the Media Center Section of the AANS Web site at: http://www.neurosurgery.org/aans.
If you would like to cover the meeting or interview a neurosurgeon - either on-site or via telephone - please contact the AANS Communications staff at (847) 692-9500 or call the Annual Meeting Press Room beginning Sunday, April 9, at (415) 978-3715 (3716).
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