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Patients were grouped according to whether they received NS. Our primary outcome was cognitive disability at 28\u00a0days or discharge (whichever occurred first), measured by the Disability Rating Scale (DRS). A DRS score\u2009&lt;\u200912 was considered a favorable outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 405 patients: 29.9% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009121) received NS and 70.1% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009284) did not. The most common NS was amantadine (97.5%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009118). The median time to NS initiation was 8.0\u00a0days (5.0\u201313.5), and the median treatment duration was 12.0\u00a0days (5.5\u201317.0). NS patients had worse injury severity scores (29 vs. 26,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02), had more neurosurgical interventions (64.4% vs. 33.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001), and were less likely to have a favorable outcome (30.8% vs. 67.1%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001). In a subgroup analysis of only NS patients, individuals receiving NS within 7\u00a0days of admission were three times as likely to have a favorable outcome compared to those receiving NS\u2009&gt;\u20097\u00a0days after admission (odds ratio 3.01, 95% confidence interval 1.11\u20138.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Nearly a third of patients with severe TBI received NS. Patients receiving NS were more injured and had worse disability at discharge compared to non-NS patients. However, among patients who received NS, treatment within 7\u00a0days was associated with an increased odds of a favorable outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s12028-025-02400-3","type":"journal-article","created":{"date-parts":[[2025,11,4]],"date-time":"2025-11-04T23:37:40Z","timestamp":1762299460000},"page":"486-495","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neurostimulant Use and Cognitive Outcomes in Patients with Acute, Severe Traumatic Brain Injury"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1469-3608","authenticated-orcid":false,"given":"Brett","family":"Tracy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shruthi","family":"Srinivas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Nahum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Payne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Roden-Foreman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Liveris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Kincaid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Doris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Brigode","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Stecher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanya","family":"Egodage","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Tigano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaushik","family":"Mukherjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liz","family":"Penaloza-Villalobos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"McBride","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"issue":"1","key":"2400_CR1","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1097\/HTR.0000000000000537","volume":"35","author":"AR Rabinowitz","year":"2020","unstructured":"Rabinowitz AR, Watanabe TK. 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