One-Year Outcomes After Traumatic Brain Injury and Early Extracranial Surgery in the TRACK-TBI Study. JAMA Netw Open 2025 Oct 01;8(10):e2537271
Date
10/10/2025Pubmed ID
41071547Pubmed Central ID
PMC12514633DOI
10.1001/jamanetworkopen.2025.37271Scopus ID
2-s2.0-105018397976 (requires institutional sign-in at Scopus site)Abstract
IMPORTANCE: Exposure to extracranial (EC) surgery early after traumatic brain injury (TBI) is associated with cognitive risks.
OBJECTIVE: To examine whether exposure to EC surgery during a TBI index admission is associated with worse outcomes at 1 year compared with no EC surgery.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective secondary nested cohort study of the prospective, observational Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort study that enrolled participants from February 1, 2014, through August 31, 2018, at 18 US level I trauma centers. Participants aged 17 years or older who were admitted to an inpatient unit from the emergency department (ED) within 24 hours of trauma, had a known Glasgow Coma Scale (GCS) score and head computed tomography (CT) imaging, and did not undergo intracranial surgery were followed for up to 1 year after TBI and were analyzed for this study from July 25, 2023, to July 2, 2025.
EXPOSURE: Participants that underwent EC surgery during the index admission were compared with nonsurgical participants within the following injury subgroups: orthopedic trauma controls (OTCs), moderate-severe TBI (GCS 3-12), and computed tomography (CT) scan results that were positive (CT+) or negative (CT-) for acute intracranial findings along with a GCS score of 13 to 15.
MAIN OUTCOMES AND MEASURES: Brain injury-specific functional outcomes (Glasgow Outcome Scale-Extended [GOSE-TBI]), cognition (Trail Making Test [Trails] parts A and B), Disability Rating Scale (DRS), and Quality of Life After Brain Injury-Overall Scale (QOLIBRI-OS). A fixed-effects linear regression model with propensity weighting for missing outcome and group imbalance in baseline characteristics was used.
RESULTS: Of the 1835 participants, 1279 (70%) were male, with mean (SD) age of 42.2 (17.8) years; 1349 participants (74%) were nonsurgical and 486 (26%) underwent EC surgery. In the 1150 participants (63%) followed up at 1 year, after propensity weighting, patients undergoing EC surgery in both the CT+ TBI and moderate-severe TBI subgroups had significantly worse GOSE-TBI (B, -0.57 [95% CI, -0.92 to -0.22] and -1.25 [95% CI, -1.65 to -0.85], respectively), Trails part B (B, 22.7 [95% CI, 7.4-38.1] and 47.9 [95% CI, 27.0-68.8]), and DRS (B, 2.47 [95% CI, 1.30-3.64] and 3.53 [95% CI, 2.19-4.87]) scores compared with nonsurgical participants. QOLIBRI-OS was worse after EC surgery vs no EC surgery in the subgroup with moderate-severe TBI (B, -15.1 [95% CI, -24.3 to -5.9]). There was no association of EC surgery with outcomes in the OTC or CT- TBI subgroups. For example, GOSE-TBI was not associated with EC surgery in the CT- TBI subgroup (B, 0.02 [95% CI, -0.24 to 0.27]).
CONCLUSIONS AND RELEVANCE: In this cohort study, early EC surgery was associated with adverse function, cognition, and disability after TBI rated as moderate-severe or with radiographic abnormalities on CT scan regardless of GCS at index admission but not after orthopedic trauma or CT- TBI. Further studies may help determine whether surgical timing or other interventions can improve the observed long-term deficits.
Author List
Roberts CJ, Maiga AW, Barber J, Temkin NR, Vala R, Patel MB, Robertson CS, Valadka AB, Yue JK, Markowitz AJ, Manley GT, Nelson LD, Transforming Clinical Research and Knowledge in TBI (TRACK-TBI) Investigators, Duhaime AC, Foreman B, Grandhi R, Keene CD, Krishnamoorthy V, Mac Donald C, McCrea M, Merchant R, Ngwenya LB, Puccio A, Rodgers RB, Schnyer D, Taylor SR, Zafonte RAuthor
Christopher J. Roberts MD, PhD Associate Professor in the Anesthesiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AdultBrain Injuries, Traumatic
Female
Glasgow Coma Scale
Humans
Male
Middle Aged
Prospective Studies
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
