Page 60 - DECISION-MAKING IN SEVERE TRAUMATIC BRAIN INJURY PATIENT OUTCOME, HOSPITAL COSTS, AND RESEARCH PRACTICE

Chapter 2
In addition, a humanistic approach on the quality of life after TBI is needed to explore what can be considered a favorable and desirable outcome for patients, their proxies and for society as a whole. Also, an accurate calculation of hospital and postdischarge healthcare costs following TBI must be undertaken, to improve hospital and public management planning and allocation of appropriate budgets.
Finally, we believe that the currently used s-TBI category remains very heterogeneous. Future research should aim for better characterization and understanding of individual pathophysiology, and identification of subgroups of patients more likely to benefit from specific therapies. Both could hopefully inform more targeted treatment according to specific patient needs.
CONCLUSIONS
The most severely injured TBI patients including patients with penetrating brain injury, frequently confront physicians with great medical and ethical conflicts. This literature review reports that although mortality rates are high and unfavorable outcome is frequent, good outcome is possible for patients with very severe TBI. Multiple different patient and injury specific factors, combined with treatment timing and type of intervention, showed to be related to intervention and outcome. Most important are age, GCS and pupillary abnormalities. Clearly, vs-TBI patients are different from the less severe TBI patients (GCS 6-8) and therefore should be recognized and treated as such. Until the availability of solid evidence, physicians must find an equilibrium between falsely withholding surgical intervention from patients with potential good outcome and aggressive treatment with an inevitable unwanted outcome.
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