Functional Recovery and Determinants of Poor Clinical Outcome After Traumatic Brain Injury: A Prospective Cohort Study at Lahore General Hospital

Abstract

Background: Traumatic brain injury is a major cause of long-term neurological disability, cognitive impairment, functional dependence, and reduced quality of life. Objective: To evaluate functional recovery and determinants of poor clinical outcome after traumatic brain injury among patients managed at Lahore General Hospital. Methods: This prospective cohort study included 54 patients with mild, moderate, or severe traumatic brain injury. Baseline demographic, clinical, radiological, neuropsychological, rehabilitation-related, and 12-month outcome variables were assessed. Poor clinical outcome was analyzed in relation to injury severity, admission Glasgow Coma Scale score, cranial CT findings, psychiatric history, sleep disturbance, employment status, education, and age. Results: Favorable functional recovery at 12 months was achieved in 36 patients (66.7%), while 18 patients (33.3%) had unfavorable outcomes. Independent ambulation was achieved in 39 patients (72.2%), return to employment in 29 (53.7%), and mortality occurred in 4 (7.4%). Significant predictors of poor outcome included unemployment after injury (OR 4.53, 95% CI 1.55–13.22), Glasgow Coma Scale ≤8 (OR 4.11, 95% CI 1.39–12.14), previous psychiatric history (OR 3.76, 95% CI 1.18–11.97), severe traumatic brain injury (OR 3.42, 95% CI 1.21–9.67), age >45 years (OR 2.94, 95% CI 1.08–8.02), abnormal cranial CT findings (OR 2.88, 95% CI 1.02–8.13), and sleep disturbance (OR 2.69, 95% CI 1.01–7.14). Conclusion: Functional recovery after traumatic brain injury is influenced by neurological severity, radiological injury burden, psychiatric history, sleep disturbance, age, and post-injury occupational reintegration. Early risk stratification and multidisciplinary rehabilitation may improve long-term outcomes