Endoscopic Endonasal Optic Nerve Decompression for Traumatic Optic Neuropathy: A Systematic Review.

Early prediction of short- and long-term health outcomes remains a significant medical challenge for clinicians providing care for the traumatic brain injury (TBI) population. In the context of an acute trauma care center, accurate and early prediction of patient outcomes at discharge is critical to better plan for services required by patients with TBI. In acute care settings, the rapid determination of patients’ needs for rehabilitation services is a primary goal. The ability to determine an appropriate discharge plan in a timely manner based on data-driven probable outcomes is not only important to clinicians and researchers but also to patients and their families. Functional cognitive independence is one outcome often assessed for individuals who have experienced a TBI in their lifetime. This outcome is characterized as the extent to which a patient can comprehend, express, socially interact, problem-solve, and remember information without assistance or supervision in daily life and is often measured by the Functional Independence Measure–Cognitive (FIM-Cog). Serial and routine assessment of FIM-Cog for patients with TBI during recovery has historically been imperative for clinicians and patients to set rehabilitation goals, track progress, and coordinate care. By measuring the comprehensive cognitive and communication difficulties a patient faces during recovery, FIM-Cog scores can help rehabilitation specialists develop targeted and effective treatment plans that provide a clear benchmark to set attainable rehabilitation goals. Despite the vast improvements in emergency care and rehabilitation within the health care system, the long-term impact of post-TBI cognitive function and its associated components remains heterogeneous. Previous research observes TBI survivors demonstrating functional cognitive disabilities long after the initial injury that vary in severity. Patients with TBI experience a slowed or plateaued recovery in FIM-Cog one year or earlier post-injury, or show improvement, no change, or worsened FIM-Cog over time. Of a total of 927 patients from the TBI Model Systems (TBIMS) National Database, 26% patients improved, 61% stayed the same, and 14% worsened by more than one point of FIM-Cog five years post-TBI, with its social interaction subscale observing 12% improvement, 76% no change, and 11% reduction, supported by a dose–response relationship with injury severity and functional outcome six months post-TBI. Although this analysis was observed to reveal three possible longitudinal trajectories of FIM-Cog recovery, this approach may overlook the potential revelation of unobserved, nonlinear trajectories of subgroups of patients that warrant identification to push patient-centered precision medicine to the forefront.