Early care withdrawal may limit recovery after severe TBI, study suggests

Over a third of severe TBI patients could regain partial independence if life-sustaining care continues, new research suggests.

The study challenges assumptions about early withdrawal of care, suggesting that meaningful recovery is possible at a higher rate than many clinicians and families might expect.

The research, led by University of Pittsburgh School of Medicine clinical scientists and UPMC neurosurgeons, analysed data from more than 500 people with severe TBI and compared outcomes between those whose life-sustaining therapies were withdrawn and those who continued to receive care.

Shawn R. Eagle, research assistant professor in the department of neurological surgery at Pitt and lead author, said: “This research calls into question the long-held belief that odds of meaningful recovery are poor in most severe TBI cases.

“Our data show that meaningful recovery is not only possible but occurs at a rate higher than many clinicians and families might expect.

“Even among patients with the most severe injuries, optimism for recovery is warranted, and decisions to withdraw care should be made with caution and compassion.”

Recovery was observed across all injury types, including those with the most severe prognoses.

More than one third of patients who were fully dependent on life-supporting care at three months achieved meaningful independence by 24 months, defined as being able to spend eight or more hours a day independently.

Nearly one in four survivors regained partial independence between six and 24 months post-injury, and more than one in 10 improved between 12 and 24 months.

David Okonkwo, neurosurgeon and director of neurotrauma at UPMC, as well as professor of neurological surgery and clinical director of the Brain Trauma Research Program at Pitt, said: “Families deserve time, transparency and care plans that evolve with the patient’s status.

“Decisions about withdrawing life-sustaining therapy should be individualised and made cautiously, resisting therapeutic nihilism when meaningful recovery remains possible.”

The findings build on earlier research from the TRACK-TBI Network, of which Pitt is a member, that first showed a substantial proportion of people with severe TBI could achieve partial independence after injury, even when the initial prognosis was poor.

The latest study confirms and extends this, showing that meaningful recovery continues up to two years post-injury.

The authors emphasise that decisions about continuing or withdrawing care are personal and complex, involving medical, psychological and social considerations.

They advocate for more nuanced prognostic tools that incorporate clinical and imaging data alongside social and psychological factors.