Four out of five people with moderate to severe traumatic brain injury (TBI) who still have disorders of consciousness when entering in-hospital rehabilitation will be discharged capable of following instructions, a large study shows.

The findings mean that doctors and relatives should be cautious about withdrawal of life-sustaining therapy primarily on the basis of unconsciousness, lest the issue becomes a “self-fulfilling prophesy”, the US researchers say.

The study drew on data for almost 17,500 US patients (mean age at injury 39, 74% male) registered in a national database after admission with TBI to one of 23 hospitals between 1989 and 2019.

Half the patients had experienced a high velocity injury — for example in a car or motorbike accident — while 28% had been injured by a fall.