Multi-Outcome Trajectories in Traumatic Brain Injury

Abstract

Traumatic Brain Injury (TBI) presents a global health challenge, affecting millions of individuals annually, resulting in diverse outcome trajectories that complicate patient management. The heterogeneity in TBI outcomes, influenced by varied clinical presentations and injury responses, requires advanced analytical approaches. The analysis of trajectories using single metrics, such as the Glasgow Outcome Scale Extended Global (GOSE), falls short of capturing the multi-faceted nature of TBI progression, often overlooking the complexity of individual patient experiences. This thesis reports on two studies. First, a systematic scoping review was conducted to synthesize the current research on trajectory analysis in TBI, followed by a modeling study. This work identifies 6 distinct multi-outcome trajectories in TBI patients by employing Latent Class Mixed Models (LCMM) and clustering approaches. Utilizing longitudinal data from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury study (TRACK-TBI), a prospective multicenter observational cohort study conducted at 18 level 1 trauma centers across the United States, which includes 17 selected outcome measures collected at four time points post-injury, provides a comprehensive understanding of the heterogeneous progression of TBI. By addressing the limitations of single outcome analyses, this research contributes to a better understanding of TBI progression that can lead to the optimization of TBI management and treatment. The future integration of these trajectories will facilitate the development of personalized treatment strategies, ultimately improving patients’ recovery.