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Abstract
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INTRODUCTION: Evidence of the effect of comorbid spinal cord injury (SCI) on cognitive outcome of persons undergoing rehabilitation following newly diagnosed traumatic brain injury (TBI) is limited. We conducted a population-based study to investigate this effect.
OBJECTIVE: Cognitive outcomes in patients with TBI with and without a comorbid SCI were compared in a population-based cohort study.
SETTING/PARTICIPANTS: Adult patients diagnosed with TBI were identified and followed for one year through provincial health administrative data; those who entered inpatient rehabilitation were studied.
DESIGN: A retrospective matched cohort study using the National Rehabilitation Reporting System data of all acute care and freestanding rehabilitation hospitals in Ontario, Canada.
MAIN MEASURES: The exposure was a comorbid SCI in patients with diagnosed TBI. Exposed patients were matched to unexposed (TBI-only) on sex, age, injury severity, and income, in a ratio of one to two. Gain differences in the cognitive subscale of the Functional Independence Measure were compared between exposed and unexposed patients using multivariable mixed linear model, controlling for comorbidity propensity score, gains in motor function, and rehabilitation care indicators.
RESULTS: Over the first year post injury, 12,750 (0.84%) of all TBI patients entered inpatient rehabilitation, of whom 1,359 (10.66%) had a comorbid SCI. A total of 1,195 exposed patients (65.4% male, mean age 50.9 ±20.6 for males and 61.8±21.8 for females) were matched to 2,390 unexposed patients. Controlling for confounding, exposed patients had lower cognitive gain (beta,-0.43; 95% CI [-0.72, -0.15]), for both males (beta -0.39; 95% CI [-0.75, -0.03]) and females (beta, -0.51; 95% CI [-0.97, -0.05]) patients. The adverse effects of comorbid SCI were driven largely by lower gains in problem solving and comprehension.
CONCLUSIONS: Adult patients with TBI and comorbid SCI showed a lower cognitive domain response to inpatient rehabilitation than patients with TBI alone. Identifying patients at risk for worse cognitive outcomes may facilitate development of targeted strategies that improve cognitive outcomes. Level III Retrospective Study. This article is protected by copyright. All rights reserved.
Language: en |