ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurotrauma
Duration of the posttraumatic confusional state after moderate and severe traumatic brain injury: impact of injury severity and preinjury factors
Camilla Sæterstad 1
Rabea Iris Pantelatos 1
Jonas Stenberg 1,2
Kent Gøran Moen 3,4,5,6
Asta Kristine Håberg 1,3
Anne Vik 1,6
Toril Skandsen 1,7
1. Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway, Sør-Trøndelag
2. Department of Clinical Sciences, Danderyd Hospital, Division of Rehabilitation Medicine, Karolinska Institutet, Stockholm, Sweden
3. Department of Radiology and Nuclear Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
4. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway, Sør-Trøndelag, 7491
5. Department of Radiology, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
6. Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway, Sør-Trøndelag
7. Clinic of Rehabilitation, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
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Abstract
Introduction: This study aimed to estimate the duration of the posttraumatic confusional state (PTCS) and predictors of the duration after moderate and severe traumatic brain injury (TBI) in a prospective inception cohort. Materials and methods: In 424 surviving neurosurgical patients with moderate (Glasgow Coma Scale (GCS) score 9-13) or severe TBI (GCS score ≤8), PTCS duration was estimated from sources documenting confusion or amnesia. Associations between PTCS duration and age, sex, indices of injury severity, and proxies of cognitive (education) and brain reserve (preinjury brain-related disability) were analyzed using binary logistic regression. Results: The most common PTCS duration was ≤7 days in the moderate TBI group (58%) and >28 days in the severe TBI group (52%). In multivariable analyses, lower age (p<0.001), higher education, higher GCS score (p<0.001), lower Rotterdam CT score (p=0.004-0.002) and no road traffic accident (p=0.006) were associated with a PTCS duration ≤7 days. Higher age (p<0.001), lower GCS score (p<0.001), and higher Rotterdam CT score (p<0.001) were associated with a PTCS duration >28 days. Proxies of brain reserve were not independently associated with PTCS duration. Conclusion: Cognitive reserve was associated with short, but not long, PTCS, while the proxy of brain reserve was not associated with PTCS. Age and injury-related variables were most consistently associated with PTCS duration. These results support the notion that PTCS is a foreseeable clinical phase after TBI, determined mainly by the brain injury itself.
Summary
Keywords
brain reserve, Cognitive Reserve, Craniocerebral Trauma, Education, Posttraumatic amnesia, posttraumatic confusional state
Received
14 November 2024
Accepted
19 January 2026
Copyright
© 2026 Sæterstad, Pantelatos, Stenberg, Moen, Håberg, Vik and Skandsen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Toril Skandsen
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