Citation

Walker WC, McDonald SD. PM R 2011; 3(1): 6-12.

Affiliation

Division of Research, Hunter Holmes McGuire Veterans Affairs Medical Center (VAMC), Richmond, VA; Defense and Veterans Brain Injury Center; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University(†).

Copyright

(Copyright © 2011, American Academy of Physical Medicine and Rehabilitation, Publisher Elsevier Publishing)

DOI

10.1016/j.pmrj.2010.11.001

PMID

21257127

Abstract

OBJECTIVE: To determine whether combining basic neurologic examination measurements with posttraumatic amnesia (PTA) duration can enhance prediction accuracy in moderate-to-severe traumatic brain injury (TBI). DESIGN: A descriptive between-subjects study. SETTING: Multicenter: 4 Veterans Affairs Brain Injury Rehabilitation Centers within the Defense and Veterans Brain Injury Center network. PARTICIPANTS: A total of 210 patients (active duty, veteran, or military dependent) with moderate-to-severe nonpenetrating TBI who consented during acute rehabilitation for data collection and completed relevant baseline and 12-month follow-up evaluations. METHODS: Multivariate analysis on neurologic examination predictor variables (upper extremity paresis, lower extremity paresis, Romberg test, and Kurtzke Expanded Disability Status Scale [EDSS]) was performed with block logistic regression modeling that controlled for duration of PTA. MAIN OUTCOME MEASURE: Glasgow Outcome Score at 1 year. RESULTS: Glasgow Outcome Score prediction accuracy by using PTA duration was modestly improved with the included neurologic examination measurements. The most influential predictor among them was EDSS, a composite measurement of neurologic impairment. When EDSS was excluded, the simple measurements of upper limb paresis and the Romberg test also provided independent prognostic value. CONCLUSIONS: This study demonstrated that simple clinical measurements of neurologic impairment (limb paresis, imbalance, other neurologic deficits) are of value in refining the prediction of long-term global outcome from TBI. These measurements may serve as markers of focal injury not captured by PTA duration, a severity marker weighted toward diffuse injury.

Language: en