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.

Key Words: Amnesia, Brain injuries, Confusion, Delirium, Psychotic disorders, Rehabilitation, Treatment outcome