Article

OBJECTIVE: To investigate recovery of medical decision-making capacity (MDC) over
6 months in persons with traumatic brain injury (TBI) stratified by injury
severity. DESIGN: Longitudinal study comparing controls and patients with TBI 1
month after injury (t1) and 6 months after injury (t2). SETTING: Inpatient TBI
rehabilitation unit and outpatient neurology department. PARTICIPANTS:
Participants (N=151) consisted of control subjects (n=60) and patients with TBI
(n=91) stratified by injury severity: mild TBI (mTBI; n=27), complicated mild TBI
(cmTBI; n=20), and moderate/severe TBI (msevTBI; n=44). INTERVENTIONS: Not
applicable. MAIN OUTCOME MEASURES: We used the Capacity to Consent to Treatment
Instrument to evaluate MDC performance on 5 consent standards (expressing choice,
reasonable choice, appreciation, reasoning, and understanding). We also assigned
capacity impairment ratings on the consent standards to each participant with TBI
using cut scores referenced to control performance. RESULTS: Control performance
was stable across time on the consent standards. Patients with mTBI and cmTBI
performed below controls on the understanding standard at t1 but not t2. Patients
with msevTBI performed below controls on appreciation, reasoning, and
understanding at t1, and on appreciation and understanding at t2, but showed
substantial improvement over time. CONCLUSIONS: Regardless of injury severity,
all groups with TBI demonstrated baseline impairment of MDC with subsequent
partial or full recovery of MDC over a 6-month period. However, a sizeable
proportion of individual patients with TBI in each group continued to demonstrate
capacity compromise at 6 months postinjury. Clinically, this finding suggests
that individuals with TBI, regardless of injury severity, need continued
monitoring regarding MDC for at least 6 months after injury.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS