One of the most complicated issues following a severe traumatic brain injury resulting in prolonged unconsciousness is the ability to predict long-term prognosis.
Life or death? Will the person ever regain consciousness? Long term disability? These are just some issues and questions faced by family and friends.
Advances in medical care have resulted in many lives being saved, but questions of outcome are still difficult to answer.
A new study reports blood tests taken the day of a traumatic brain injury (TBI) can accurately predict which patients are likely to die or survive with severe disability. The study team measured the biomarkers in blood samples taken from patients with TBI on the day of their injury and then evaluated their recovery six months later.
The study found that higher values of two protein biomarkers, are associated with death and severe injury was published in the journal. Lancet Neurology, September 2022.
A full reference for the article can be found in the notes accompanying this discussion:
“Prognostic value of day-of-injury plasma GFAP and UCH-L1 levels for predicting functional recovery in the TRACK-TBI cohort: an observational cohort study.” Sept 2022. Lancet Neurology; 21:803-813.
High levels on the day of injury were strong predictors of death and outcomes such as the persistent vegetative state or severe disability requiring daily assistance to function.
Those with biomarker levels among the highest fifth were at greatest risk of death in the six months post-TBI, with most occurring within the first month.
While the study may inform families and clinicians, I am concerned this information may be misused to deny care to those in need.
Here is a statement on using these biomarkers by one of the study authors, “Brain injury biomarkers will one day be the standard of care to evaluate and treat patients,” “Objective biomarker data can be profoundly helpful in determining prognosis for a patient, helping to gauge how severe a brain injury is, and can ultimately inform how best to counsel family members about care for their loved ones with brain injury.”
While statistical probability is useful, using statistics to predict outcome may adversely influence decision making by clinicians and insurance companies. In reading news reports of this study, I am shocked to see no discussion of this serious ethical issue and all its implications.
These tests should not be used by medical practitioners or by insurance carriers to pressure family members on decision making regarding aggressiveness of care or withdrawing life sustaining therapies.
Studies in the past have found that individuals in various states of unconsciousness thought to have no level of awareness had conscious awareness.
Let’s not be so quick to write off a person who has sustained a severe traumatic brain injury. In my legal practice and in my interactions with family members and injured individuals, I have come to learn that every injury is unique, and one can never give up hope.
Thank you for listening, and I look forward to speaking with you again next week on a new edition of The Brain Injury Insider.