Long-Term Outcome Following Traumatic Brain Injury

Abstract

The question of long-term outcome is one that needs to be considered at all stages and severity of traumatic brain injury (TBI). In cases of mild and relatively moderate head injury, patients and their families will often be concerned regarding issues such as restoration of neurocognitive function, social reintegration, and return to work. For the more severe injuries, the initial concerns may revolve around the issues of life and death and thereafter the possibility of survival with severe disability.

However, notwithstanding the clinical value of a number of assessment tools, long-term outcome is usually dichotomized into favorable or unfavorable, the implication being that for a therapy to be considered beneficial, more patients in the intervention arm of a trial should achieve a favorable outcome, and from a research perspective, this is an entirely reasonable approach. However, for an individual patient and their families, adopting this position can be problematic.

Many patients who have had a relative mild head injury go on to make a full recovery; however, the favorable outcome category also includes patients with moderate disability, and this by definition includes patients whose work capacity is reduced and who have ongoing personality and interpersonal problems. The impact that these issues have on an individual and their families can be significant, and in certain cases, the term “favorable” may fail to adequately describe their perceived outcome. Likewise, there are certain patients who survive in the unfavorable outcome category who appear perfectly happy. The question remains as to how this should be approached from a clinical and ethical perspective such that patients and families can be counseled appropriately regarding realistic long-term outcome expectations.