TOPLINE:

Undergoing early extracranial (EC) surgery after traumatic brain injury (TBI) was associated with worse 1-year functional, cognitive, and disability outcomes than forgoing surgery in patients with abnormalities on CT scans (CT-positive TBI) or with moderate-to-severe TBI, new research showed.

METHODOLOGY:

• Researchers performed a retrospective secondary analysis of the prospective TRACK-TBI cohort study, which was conducted across 18 US level I trauma centers from 2014 to 2018.
• They included more than 1800 adults (mean age, 42 years; 70% men; 78% White) admitted to an inpatient unit from the emergency department within 24 hours of trauma. All had a known Glasgow Coma Scale (GCS) score, an indication for head CT, and no intracranial surgery.
• Outcomes were compared between participants who underwent EC surgery during the index admission (26%) and those who received nonsurgical treatment (74%). The latter included the following injury subgroups: CT-negative TBI with GCS scores 13-15, CT-positive TBI with GCS scores 13-15 (sometimes called “mild TBI”), moderate-to-severe TBI (GCS scores 3-12), or non-TBI orthopedic trauma (control group). Patients were followed for 1 year.
• Functional outcomes were measured using the Glasgow Outcome Scale-Extended (GOSE) for all injuries and the GOSE for brain injury. Other measures included the Trail Making Test Parts A (processing speed) and B (executive functioning), the Disability Rating Scale, and the Quality of Life (QOL) After Brain Injury - Overall Scale.

TAKEAWAY:

• In the moderate-to-severe TBI subgroup, EC surgery was associated with more TBI- and injury-related functional limitations, increased disability, poorer processing speed and executive function, and lower TBI-related QOL than no surgery (P ≤ .03 for all).
• In the CT-positive TBI subgroup, EC surgery vs no surgery was associated with more TBI- and injury-related functional limitations (P = .002 and P < .001, respectively), increased disability (P < .001), and poorer executive functioning (P = .004), but there were no differences in processing speed and QOL scores.
• No significant associations were found between EC surgery and any outcomes in the CT-negative TBI and control groups.
• In sensitivity analyses, differences in the CT-positive TBI group remained significant for overall function and cognitive measures but were no longer significant for TBI-specific function and disability.

IN PRACTICE:

“These findings suggest that imaging might be more valuable in assessing vulnerability to secondary insults than clinical assessments of alertness and responsiveness,” the investigators wrote. 

“Further studies may help determine whether surgical timing or other interventions can improve the observed long-term deficits,” they added.

SOURCE:

The study was led by Christopher J. Roberts, MD, PhD, Medical College of Wisconsin, Milwaukee. It was published online on October 10 in JAMA Network Open.

LIMITATIONS:

The study was limited by potential confounding by indication and had unquantified variables such as delirium, which has shown mixed associations with long-term cognitive impairment in past research. Individual patient trajectories, which vary for TBI-induced insomnia and neuropsychiatric symptoms, were not examined. Additionally, the observational design demonstrated an association but could not establish causality or identify pathophysiologic mechanisms. 

DISCLOSURES:

The study was funded by the National Institutes of Health, National Institute of Neurological Disorders and Stroke, Department of Defense, the Weill Family Foundation, One Mind for Research, NeuroTrauma Sciences, and Abbott Laboratories. Several investigators reported having financial and other ties with various organizations. Full details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.