Effect of Severity of Post-Traumatic Confusion and Its Constituent Symptoms on Outcome After Traumatic Brain Injury
Abstract
Sherer M, Yablon SA, Nakase-Richardson R, Nick TG. Effect of severity of post-traumatic confusion and its constituent symptoms on outcome after traumatic brain injury.
Objective
To investigate the prognostic significance of severity of post-traumatic confusion (PTC) and its constituent symptoms for early and late outcome after traumatic brain injury (TBI).
Design
Prospective cohort study.
Setting
Inpatient brain injury rehabilitation program.
Participants
A total of 168 patients meeting study criteria from 195 consecutive Traumatic Brain Injury Model Systems neurorehabilitation admissions.
Interventions
Not applicable.
Main Outcome Measures
Employability at neurorehabilitation discharge and productivity status at 1 year postinjury.
Results
More severely confused patients had poorer outcomes for both employability and productivity. Multivariable logistic regression revealed that after adjustment for all other predictors, time to follow commands, and confusion severity predicted employability at discharge and age and confusion severity predicted productivity status at 1 year. Each symptom showed an unadjusted effect on discharge employability. All symptoms except nighttime sleep disturbance or daytime decreased arousal had effects on productivity at 1 year. Presence of psychotic-type symptoms was associated with especially poor productivity outcomes.
Conclusions
PTC constituent symptoms and severity predict outcome after TBI. Presence or absence of psychotic-type symptoms on a single evaluation at approximately 21 days postinjury may have particular prognostic significance for productivity outcome.
dUniversity of Mississippi Medical Center, Jackson, MS
eCenter for Epidemiology & Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
fUniversity of Cincinnati College of Medicine, Cincinnati, OH.
Reprint requests to Mark Sherer, PhD, ABPP-Cn, Dept of Research, Memorial Hermann/TIRR, 1333 Moursund, Houston, TX, 77030
Supported by the National Institute on Disability and Rehabilitation Research (grant no. H133A020514) and the Traumatic Brain Injury Model System of Mississippi.
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 author(s) or upon any organization with which the author(s) is/are associated.
ABSTRACT