Researchers from the University of Alabama at Birmingham state that a traumatic brain injury (TBI) can negatively affect a patient’s medical decision-making ability at a time when patients or their families are faced with countless complex decisions.
According to a study in the April 11 issue of Neurology, the severity of the injury lies in direct correspondence to the amount of impairment, meaning that patients with mild TBI showed little impairment one month after injury, whilst those with more severe injury were significantly impaired.
The findings are significant for medical professionals, as well as family members, when assisting patients or loved one to make important medical decisions after experiencing a head injury. Until now, there has been little research on the effects of TBI on people’s ability to decide on complicated issues.
Senior researcher, Daniel C. Marson, J.D., Ph.D., professor of Neurology, and director of the UAB Division of Neuropsychology said:
“Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatric problems.”
Marson, and his team assessed 86 patients with TBI and 40 healthy controls. The TBI patients were split into three categories, depending on whether they experienced a mild, complicated mild or moderate to severe TBI. The patients were assessed using Marson’s standardized measure of medical decision-making capacity, which evaluates five different areas of consent, including understanding, reasoning, expressing choice, reasonable choice and appreciation.
Kristen Triebel, Psy.D., assistant professor of neuropsychology and first author of the study commented:
“One month after injury, medical decision-making capacity was mostly intact for those classified with mild TBI, but significantly impaired for those classified with complicated mild TBI and those with moderate/severe TBI.Until we know more about the time required for return to normal decision-making capabilities, physicians need to carefully assess decisional capacity in their TBI patients, particularly those with complicated, moderate or severe TBI.”
The team observed that the moderate-to-severe TBI group performed substantially worse on three of the five complex consent forms in comparison with the controls, namely understanding, reasoning and appreciation, whilst those with complicated mild TBI scored worse than the controls in understanding, but not in appreciation or reasoning. Those who experienced mild TBI scored the same in all forms of consent as the controls.
“This suggests that one month following injury, consent capacity has returned to normal for people with mild TBI, but the structural brain changes characteristic of complicated mild cases may contribute to more significant impairments in decisional capacity that have not resolved 30 days after injury.
This study strongly suggests that impaired medical decision-making capacity is prevalent in acute TBI and is related to injury severity. Longitudinal studies are needed to better assess the time required for recovery of decisional capacity across varying levels of injury severity.”
Written By Petra Rattue