Predicting Functional Dependency in Patients with Disorders of Consciousness: A TBI-Model Systems and TRACK-TBI Study

Ann Neurol, 2023 · DOI: 10.1002/ana.26741 · Published: December 1, 2023

Research Methodology & Design Brain Injury

Simple Explanation

This study aimed to create a tool to predict long-term dependency in patients who have disorders of consciousness (DoC) after a traumatic brain injury (TBI). The tool uses data from two large studies: TBI Model Systems (TBI-MS) and Transforming Research and Clinical Knowledge in TBI (TRACK-TBI). The prediction model incorporates factors like age, severity of brain injury, and early signs of recovery to estimate the likelihood of a patient being dependent one year after the injury.

Study Duration

Not specified

Participants

TBI-MS: 1,960, TRACK-TBI: 124

Evidence Level

Not specified

Key Findings

1
A combination of variables (age, IVH, followed commands within 5 days of injury, and severity of functional and motor impairment at admission to rehabilitation) produces a well-calibrated estimate of the probability of functional dependency at 1-year.
2
The model's accuracy was diminished in the external TRACK-TBI dataset but remained better than chance and equivalent to the IMPACT prognostic model.
3
The model was more accurate in identifying patients unlikely to remain dependent than those likely to remain dependent.

Research Summary

This study developed a 1-year functional dependency prediction model for patients with DoC after TBI using data from TBI-MS and TRACK-TBI. The model incorporates age, severity of neurological impairment, command following in the first 5 days post-injury, and intraventricular hemorrhage. The model may serve as a reliable dependency rule-out tool for patients admitted to inpatient rehabilitation but has worse performance when applied to patients still receiving acute care.

Practical Implications

Improved Prognosis

The model may help families and clinicians better understand the likelihood of long-term dependency for patients with DoC after TBI.

Clinical Trial Stratification

The model can be used to identify patients at high or low risk for functional dependency at 1 year, improving statistical power in clinical trials.

Personalized Care Planning

The information provided by the model may be useful for families beginning to plan for the logistics related to long-term care.

Study Limitations

1
Some important predictors may have been unmeasured or not identified due to missing data.
2
The study used a stringent dependency definition, and different predictors might be identified with less stringent criteria.
3
The model's positive predictive value was low, limiting its ability to confidently classify patients as functionally dependent.

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