{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T09:23:46Z","timestamp":1787822626932,"version":"build-2784847793"},"reference-count":46,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,9]],"date-time":"2026-08-09T00:00:00Z","timestamp":1786233600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100009006","name":"Integra LifeSciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009006","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ann Clin Transl Neurol"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Reserve refers to the brain's ability to maintain function after an injury and strongly relates to traumatic brain injury (TBI) outcomes. This study examined (1) whether associations between pre\u2010injury reserve proxies and outcomes differed across injury severity categories, and (2) whether the impact of injury severity varied across functional, symptomatic, and cognitive outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This observational cohort study used data from CENTER\u2010TBI. Of 4509 enrolled patients, 3377 were between 18 and 75\u2009years and alive 6\u2009months post\u2010injury. Outcomes included functional outcome (GOSE,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20092790), self\u2010reported symptoms (RPQ,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091470), and cognition (composite score,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091968). Pre\u2010injury reserve proxies were education, age, and psychiatric history. Injury severity was categorized as uncomplicated mild TBI, complicated mild TBI, moderate, and severe TBI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of nine tested interactions between reserve proxies and injury severity, only the interaction of age with injury severity on cognition was significant (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.1,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), with age being less influential in severe TBI. Higher education and no psychiatric history predicted better outcomes across all severities. Younger age predicted more favorable GOSE and cognitive scores. RPQ symptoms peaked among adults aged 46\u201360. Increasing injury severity was associated with progressively lower odds of GOSE \u2265\u20096. RPQ scores plateaued in moderate TBI. Cognitive performance was similar in uncomplicated and complicated mild TBI.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>Pre\u2010injury reserve proxies predicted outcome largely independent of injury severity, with higher reserves linked to better recovery. Injury severity showed a graded relationship with functional outcome. Symptom burden and cognitive impairment demonstrated non\u2010linear patterns across severity categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT0221022\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acn3.70509","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T03:45:31Z","timestamp":1786333531000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reserves, Injury Severity, and Outcomes in Traumatic Brain Injury: A\n                    <scp>CENTER<\/scp>\n                    \u2010\n                    <scp>TBI<\/scp>\n                    Observational Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3656-995X","authenticated-orcid":false,"given":"Natascha","family":"Ekdahl","sequence":"first","affiliation":[{"name":"Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet  Stockholm Sweden"},{"name":"Center for Research and Development Uppsala University\/County Council of G\u00e4vleborg  G\u00e4vle Sweden"},{"name":"Faculty of Health and Occupational Studies University of Gavle  G\u00e4vle Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marika C.","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Rehabilitation Medicine Danderyd University Hospital  Stockholm 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Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5769-7959","authenticated-orcid":false,"given":"Jonas","family":"Stenberg","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences Danderyd Hospital, Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Rehabilitation Medicine Danderyd University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"CENTER\u2010TBI participants and 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