• Samantha Kanny and Joseph T Giacino.
• Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Charlestown.
• Curr Opin Crit Care. 2025 Jan 10.

Purpose Of ReviewTo increase knowledge of the natural history of recovery and long-term outcome following severe traumatic brain injury (sTBI).Recent FindingsRecovery of consciousness and complex behaviors that presage subsequent functional recovery frequently occurs well beyond the first 7 days after injury, which is typically the time period widely used in the ICU for prognostic decision-making and establishing goals of care for. Similarly, recovery of functional independence occurs between 1 and 10 years postinjury in a substantial proportion of patients who do not recover command-following during the acute hospitalization. Data from large, multicenter studies that systematically conduct long-term follow-up with well validated measures consistently indicate that the most common trajectory of recovery after 1 year postinjury is characterized by changes, not stability, in functional status.SummaryEvidence from large multicenter studies with well characterized samples focusing on recovery trajectories beyond 1 year postinjury challenge conventional beliefs about outcome after sTBI. Signs of consciousness frequently emerge following discharge from the ICU setting and prediction of death and dependency within the first few weeks after injury is unreliable. Clinician knowledge of the frequency and time course to recovery of key behavioral milestones is central to evidence-based prognostic counseling.Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.

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