ArticlesOutcome after traumatic brain injury: Pathway analysis of contributions from premorbid, injury severity, and recovery variables☆,☆☆,★,★★
Section snippets
Subjects
Of an eligible 169 persons admitted to an intensive care unit with a diagnosis of TBI and participating in acute rehabilitation, 107 participated in the present study. Subjects were identified as having TBI if they had experienced loss of consciousness of any duration, skull fracture, PTA of any duration, or had objective neurologic findings such as alteration in mentation, cranial nerve deficits, or hemiparesis. Subjects who completed the study participated in a neuropsychologic evaluation and
Results
The subjects completing the study (table 1) were predominantly young men with a high school education or less who were injured in motor vehicle collisions. Based on GCS2 score, a majority (70.1%) of the sample had experienced a severe TBI (GCS score, 3-8); 17.7% experienced a moderate TBI (GCS score, 9-12); and 12.1% experienced a mild TBI (GCS score, 13-15). In the case of mild injuries, subjects exhibited other problems that necessitated admission to the intensive care unit, such as
Discussion
The subjects in this study were young, mostly men, and had limited education (usually because they were too young at age of injury to have completed their education). Most injuries were from motor vehicle crashes, and there was a distribution of severity of injury, although severe TBI was predominant. The cognitive difficulties encountered were comparable to what has been described elsewhere,3, 20, 27 with deficits in memory functioning and speed of mental processing being particularly evident.
Conclusion
The results of the present study underscore the need for researchers to be very circumspect when examining the relationship of individual variables to outcome. Using only a few variables, or examining 1 aspect of TBI, one may identify a relationship that would not fare well in a multivariate study. For instance, the relation between Injury Severity and Outcome is likely to be stronger if no other variables that could contribute to outcome are considered. This misunderstanding might lead to
References (32)
- et al.
Acute predictors of successful return to work 1 year after traumatic brain injury: a multicenter analysis
Arch Phys Med Rehabil
(1997) - et al.
Outcomes in the first 5 years after traumatic brain injury
Arch Phys Med Rehabil
(1998) Neuropsychiatric sequelae of head injuries
Psychiat Clin North Am
(1992)- et al.
Residential and home-based postacute rehabilitation of individuals with traumatic brain injury: a case control study
Arch Phys Med Rehabil
(1999) - et al.
Disability after severe head injury: observations on the use of the Glasgow Outcome Scale
J Neurol Neurosurg Psychiatry
(1981) - et al.
Management of head injuries
(1981) - et al.
Neurobehavioral outcome 1 year after severe head injury experience of the Traumatic Coma Data Bank
J Neurosurg
(1990) - et al.
Cognitive and psychosocial outcome following moderate or severe traumatic brain injury
Brain Inj
(1999) - et al.
Prediction of employment status 2 years after traumatic brain injury
Brain Inj
(1995) - et al.
Predicting community integration after traumatic brain injury with neuropsychological measures
Int J Neurosci
(1994)
Employment following traumatic head injuries
Arch Neurol
Prediction of employment outcome one to three years following traumatic brain injury (TBI)
Brain Inj
A uniform national data system for medical rehabilitation
Disability Rating Scale for severe head trauma: coma to community
Arch Phys Med Rehabil
Assessment of community integration following rehabilitation for traumatic brain injury
J Head Trauma Rehabil
Assessment of post-traumatic amnesia after severe closed head injury: retrospective or prospective?
J Neurol Neurosurg Psychiatry
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Supported in part by the Centers for Disease Control (grant no. R49CCR40364) and by the National Institutes of Health (grant no. HD07420).
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No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the author(s) is/are associated.
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Reprint requests to Thomas A. Novack, PhD, University of Alabama at Birmingham, Spain Rehabilitation Center, Dept of Physical Medicine and Rehabilitation, 1717 6th Ave S, Birmingham, AL 35233, e-mail: [email protected].
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