An early clinical assessment may overestimate the severity of neurologic damage in a patient with traumatic brain injury (TBI).

Patient selection: traumatic brain injury


Timing: clinical examination soon after admission


Some reasons for overestimation of neurologic damage:

(1) sedation

(2) patient intoxication, including opiates given for pain

(3) administration of muscle relaxants for intubation

(4) sleep deprivations

(5) language problems

(6) concussion


Features of a patient who may show a better than expected neurologic recovery:

(1) no surgical intracranial masses

(2) able to obey commands after a few days

(3) discharged from the ICU in <= 3 days

(4) higher Glasgow coma scale

(5) younger age

(6) mild changes on brain CT

(7) no or mild pupillary abnormalities

(8) low serum levels of biomarkers

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