Okay, for our penultimate presentation, we have a late-breaking abstract, and we'll invite Tiffany Wilkins up to talk about what's also a very hot topic in our field right now, and that's duration of follow-up after TBI and how it relates to outcome. Thank you. Hello. My name is Tiffany Wilkins. I just recently graduated from medical school, and I'm currently at University of Pittsburgh doing some research with Dr. Okonkwo. So I'm going to be talking about favorable functional recovery from severe traumatic brain injury beyond six months. And there are no disclosures. Okay, so favorable long-term outcomes in severe TBIs are underappreciated, and the nihilism amongst neurosurgical providers regarding severe TBIs still remains pervasive and insidious. And an example, Kauffman and colleagues performed a study. They asked a neurosurgeon to predict the long-term outcomes of 100 consecutive severe TBI patients, and the outcome was that they overestimated bad outcomes 50% of the time, and they underestimated favorable outcomes 50% of the time. So there's a lot of factors involved in severe TBIs, so it can be very challenging to have an accurate prognosis. So we maintained a database of prospective consecutive severe TBI patients at our institution, and we used the BTRC data to evaluate the evolution of outcomes from three months to 24 months. And we looked at patients from 2003 to 2017. And the inclusion criteria to be enrolled in this study were patients who were 16 to 80 years old, they weren't following commands, and they had a severe TBI as defined by GCS of less than or equal to eight. And the exclusion criteria is shown here as well. So for our methods, we, for analysis, we used Wilcoxon-signed brain tests, and we also used descriptive statistics to quantify the nature of change, whether patients were increasing, decreasing, or staying the same, their GOSC scores. And then we also looked at the initial GCS of patients and favorable and the unfavorable outcomes at two years. And then we dichotomized GOSC into two groups. Favorable outcomes in which patients had a GOSC of four to eight, and unfavorable outcomes in which patients had a GOSC of one to three. And this dichotomization was chosen, it was the same as the RescueICP and other recent trials used. So 255 out of the 559 severe TBI patients died within 90 days. So we did not use their data in our analyses. And only 11 patients died between three and 24 months after injury. And so of the 304 surviving adults, 81% of them were male, and their mean age was 35, and their mean admission GCS was seven. So here it shows our results. The GOSC outcomes across time among patients with data at 24 months. And we looked at three, six, 12, and 24-month data. And you can see it's shown, you know, the patients with a GOSC of one to three steadily decreased over time, and patients with a GOSC of four to eight had a significant increase from three months to 24 months in their outcome. And here's a little more consolidated view showing the unfavorable versus favorable outcomes among the patients with data at 24 months. And you can see that patients in the unfavorable group went from 58% to 27% at two years, and patients in the favorable outcome group at three months went from 42% to 73% at 24 months. So it's a significant jump in how many patients had a favorable outcome at two years. So we did conclude patients demonstrated significant improvement in functional outcomes from three to 24 months following severe TBI, and this was independent of their admission GCS. It was actually, for the unfavorable outcome, the admission GCS average was five, and for favorable it was six. So it really wasn't much different. Sixty-seven percent of patients in the unfavorable outcome category at three months did improve to the favorable outcome category at two years. And overall, as I just showed you, 73% of surviving severe TBI patients had a favorable outcome at two years. So in conclusion, favorable outcomes after severe TBI are far more common than widely appreciated, and the prognostication and decision-making and the management of severe TBI should take into account these favorable long-term outcome profiles. So some limitations, unfortunately, we didn't have data past two years. So something that would be nice is to start collecting this at five and ten years to create a better long-term outcome profile, and as well as assessing the correlation of injury type with GOSC outcome data using CT imaging, I think it would be interesting to see if there's any correlation. And lastly, I would like to thank Dr. Okonkwo and acknowledge the rest of the team members that contributed to this research. That's all I have. Thank you. Do we have any questions? Yes. What was that? I actually did not look at that. So I'm not quite sure what the answer would be to that. Okay. We didn't look at that correlation, but it is interesting and something that I think should be looked at because I think that the length of rehab and the amount of social support can make a huge difference in their outcome if they move to favorable or not. Thank you. Okay.

traumatic brain injury

functional recovery

neurosurgical providers

severe TBI outcomes

favorable outcomes