McCrea MA, Giacino JT, Barber J, et al. - In this cohort study, between 2 weeks and 12 months after injury, patients with moderate to severe traumatic brain injury (msTBI) typically showed considerable functional gains, including recovery of independence. In a significant minority of individuals with msTBI, severe impairment in the short term did not predict poor outcomes. Clinicians should be especially cautious about making early, definitive prognostic comments implying poor outcomes and discontinuation of life-sustaining treatment in patients with msTBI when discussing prognosis during the first 2 weeks following injury.

• In total, 484 eligible patients were involved from the 2,679 people in the TRACK-TBI study.

• On demographic and premorbid factors, participants with severe TBI (n = 362; 283 men [78.2%]; median [interquartile range] age, 35.5 [25-53] years) and moderate TBI (n = 122; 98 men [80.3%]; median [interquartile range] age, 38 [25-53] years) were comparable.

• At 2 weeks after the injury, 36 of 290 candidates with severe TBI (12.4%) and 38 of 93 candidates with moderate TBI (41%) had favorable outcomes (GOSE scores 4-8); 301 of 322 in the severe TBI group (93.5%) and 81 of 103 in the moderate TBI group (78.6%) had a moderate disability or worse on the Disability Rating Scale (DRS) [total score ≥ 4].

• By 12 months after the injury, 142 of 271 people with severe TBI (52.4%) and 54 of 72 people with moderate TBI (75%) had positive outcomes.

• At 12 months, nearly 1 in every 5 participants with severe TBI (52 of 270 [19.3%]) and 1 in every 3 with moderate TBI (23 of 71 [32%]) reported no disability (DRS score 0).

• By 12 months, 62 of 79 (78%) participants in a vegetative state had regained consciousness and 14 of 56 with available data (25%) had regained orientation.