Decision Making With a Head Injury

Traumatic brain injuries affect decision making abilities and now doctors have a range to gauge capacity

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) People with traumatic brain injuries (TBI) don’t always look as injured on the outside as they are on the inside. When it comes to making decisions, doctors and family members need to know exactly what level of injury exists.

In a recent study done at the University of Alabama at Birmingham (UAB), senior author Daniel C. Marson, J.D., Ph.D., professor of Neurology, director of the UAB Division of Neuropsychology, looked into what happens to decision making capacity one month after a TBI.

"Be aware that decision-making may be impaired after TBI."

Marson states, "Immediately following injury and during the rehabilitation and recovery period, patients and their families must make ongoing and often complex medical decisions, including treatment of brain trauma and orthopedic injuries, choice of rehabilitation programming and treatment of neuropsychiatric problems."  

According to the UAB team, up until now there hasn't been very much research published on how well a TBI patient is able to make medical decisions based on full understanding of the situation.  

Marson’s research team took a look at 86 TBI patients from three categories ranging from mild, complicated mild and moderate/severe one month after injury. With Marson’s method each patient was ranked in one of five states of mental awareness: expressing choice, reasonable choice, appreciation, reasoning and understanding.

Kristen Triebel, Psy.D., assistant professor of neuropsychology, states, “One month after injury, medical decision-making capacity was mostly intact for those classified with mild TBI, but significantly impaired for those classified with complicated mild TBI and those with moderate/severe TBI”.

In the study, the mild TBI patients did comparatively as well as patients without TBI in all five states of mental awareness. The complicated mild patients did well on all four states except the ‘understanding’ category. The moderate/severe TBI patients demonstrated far lower capacity with the ‘appreciation’, ‘reasoning’ and ‘understanding’ states than all of the other groups.

Marson said after completing the study, “Longitudinal studies are needed to better assess the time required for recovery of decisional capacity across varying levels of injury severity.”

This study was published in the medical journal of the American Academy of Neurology, Neurology, April 11, 2012. Funding came from the National Institute on Child Health and Human Development. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
April 11, 2012
Last Updated:
April 13, 2012