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Limited predictive power of hospitalization variables for long‐term cognitive prognosis in adult patients with severe traumatic brain injury
Author(s) -
Oliveira Thais Maria Emília Rodrigues,
Cavallazzi Gisele,
Formolo Douglas Afonso,
Castro Lucas D'Ávila,
Schmoeller Roseli,
Guarnieri Ricardo,
Schwarzbold Marcelo Liborio,
Diaz Alexandre Paim,
Hohl Alexandre,
Prediger Rui D. S.,
Mader Maria Joana,
Linhares Marcelo Neves,
Staniloiu Angelica,
Markowitsch Hans J.,
Walz Roger
Publication year - 2014
Publication title -
journal of neuropsychology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.85
H-Index - 37
eISSN - 1748-6653
pISSN - 1748-6645
DOI - 10.1111/jnp.12000
Subject(s) - medicine , neuropsychology , traumatic brain injury , cognition , radiological weapon , retrospective cohort study , effects of sleep deprivation on cognitive performance , pediatrics , neuropsychological assessment , surgery , psychiatry
Objectives Traumatic brain injury ( TBI ) is a main cause of mortality and morbidity. Association studies between hospitalization variables and cognitive impairment after TBI are frequently retrospective, including non‐consecutive patients showing variable degrees of TBI severity, and poor management of missing (drop out) cases. Methods We assessed prospectively the demographic and hospitalization variables of 234 consecutive patients with severe TBI (admission G lasgow C oma S cale [ GCS ] ≤8) and determined their independent association with cognitive performance in a representative sample ( n = 46) of surviving patients ( n = 172) evaluated 3 (±1.8) years after hospitalization. Results In all, 85% of patients were male and the mean age was 34 ( SD ±13) years. The education level was 9 (±4.7) years. As expected, education and age showed a moderately to strong linear relationship with the cognitive performance in 14 of 15 neuropsychological tests ( R coefficient = 0.6–0.8). The cognitive test scores were not independently associated with gender, admission GCS , associated trauma, and Marshal CT classification. Admission‐elevated blood glucose levels and the presence of sub‐arachnoid haemorrhage were independently associated with lower scores on R ey A uditory V erbal L earning retention and L ogical M emory‐I tests, respectively. Conclusions After correction for education and age distribution, the variables that are commonly associated with mortality or G lasgow O utcome S cale including admission pupils' examination, M arshal CT Classification, GCS , and serum glucose showed a limited predictive power for long‐term cognitive prognosis. Identification of clinical, radiological, and laboratory variables as well as new biomarkers independently associated with cognitive outcome remains an important challenge for further work involving severe TBI patients.