Individual Prognostication of Emergence from Post-Traumatic Amnesia: A Nationwide Cohort Study.

Abstract

To predict individual emergence from post-traumatic amnesia (PTA) in patients with moderate to severe traumatic brain injury (TBI). Prospective nationwide cohort study based on data from a national registry: Danish Head Trauma Database. Two highly specialized neurorehabilitation hospitals in Denmark. TBI patients admitted between 2004 and 2020 were included in the study. Not applicable. Duration of PTA, defined as the number of days from TBI onset until regaining anterograde memory function, is a proxy for the resolution of the confusional state. Using competing risk survival analyses, we estimated absolute risks (probabilities) of emerging from PTA according to the included covariates of interest: sex, age, severity of TBI and time since injury. 955 TBI patients (mean age 45.2 (SD=17.8), 21% female) were included in the study, of which 658 emerged from PTA within one year. In the fully adjusted model, male sex, older age, and greater TBI severity were associated with a lower probability of emerging from PTA. Among patients with severe TBI, 99 out of 100 in the youngest age group will emerge from PTA within one year, compared with 72 out of 100 in the oldest age group. Among patients with very severe TBI, the corresponding estimated probabilities are 62 and 24 out of 100 within one year, respectively. The prognostic model offers clinicians an evidence-based tool to individually predict TBI patient's probability of emerging from PTA, incorporating key prognostic factors while accounting for competing risks such as mortality and non-emergence.