Impairment and Partial Recovery of Medical Decision-Making Capacity in Traumatic Brain Injury: A 6-Month Longitudinal Study

Marson DC, Dreer LE, Krzywanski S, Huthwaite JS, DeVivo MJ, Novack TA. Impairment and partial recovery of medical decision-making capacity in traumatic brain injury: a 6-month longitudinal study. To investigate empirically change in medical decision-making capacity (MDC) in patients with traumatic brain injury (TBI). Longitudinal study comparing control and TBI groups at hospitalization and at 6 months postinjury. Inpatient brain injury rehabilitation unit. Twenty healthy controls and 24 patients with moderate to severe TBI. Not applicable. MDC was measured by using the Capacity to Consent to Treatment Instrument (CCTI). The CCTI evaluates performance on a series of 4 accepted consent abilities, or standards: S1 (evidencing/communicating choice), S3 (appreciating consequences), S4 (reasoning about treatment), and S5 (understanding the treatment situation and choices), and 1 experimental standard [S2] (making the reasonable treatment choice when the alternative choice is unreasonable). In addition, TBI patients were assigned 1 of 3 capacity outcomes (capable, marginally capable, incapable) for each standard. At hospitalization, TBI patients performed equivalently with controls on standards S1 and [S2] but significantly below controls on S3 ( P