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March 1, 2021

Holding Out Hope After Traumatic Brain Injury

Author Affiliations
  • 1Division of Neurocritical Care, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
JAMA Neurol. 2021;78(5):522-524. doi:10.1001/jamaneurol.2020.5328

Uncertainty of prognostication increases with more severe brain injury. Withdrawal of life-sustaining therapy (WLST) is often the proximate cause of death. Evidence suggests that level of consciousness may play a role in driving early WLST decisions.1 Studies have shown that many patients with traumatic brain injury (TBI) and other acute brain injuries regain consciousness within the first 72 hours, with most showing improvements in consciousness by 7 days after injury.2 However, the turning point at which a person who remains in a state of disordered consciousness will remain in this persistent state is still unclear. If no progress is seen in a patient’s arousal or awareness at 10 days or 2 weeks or 1 month, at what point do we consider pivoting our discussions about the likelihood of recovering consciousness?

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