*Poster 23: Fluctuations in Performance on the Orientation Log During Acute Recovery Predict Functional Status at Discharge Following Traumatic Brain Injury

Objective: To investigate the incidence and relevance of fluctuating performance, a required diagnostic criterion of delirium (acute confusion), during the period of posttraumatic amnesia following traumatic brain injury (TBI). Design: Retrospective cohort. Setting: Inpatient brain injury rehabilitation unit. Participants: A sample of 63 TBI patients with confusion. Confusion was defined as 2 or more assessments scoring under established cut-offs. Interventions: None. Main Outcome Measures: The Orientation Log (O-Log), collected 3 times per week, and FIM scores collected at hospital discharge. Results: In the sample, 46 participants (73%) demonstrated fluctuating performance on the O-Log, as defined by any change in direction of scores. Patients with fluctuating performance had significantly lower discharge FIM scores (t=2.05, P<.05) when compared with those patients who did not fluctuate, despite the lack of difference in admission FIM scores. Further, we examined fluctuating performance as a score's distance from a regression line using all O-Log scores as the independent variable and days since injury as the dependent variable. Fluctuating performance, age, and PTA duration were entered into a multiple regression model as predictor variables, with FIM discharge score as the outcome of interest. This model supported our initial results, indicating greater variability in performance was a statistically significant negative predictor of functional status at discharge (R²=.146, F=11.66, P<.001). Conclusions: The results suggest fluctuation is a key dimension of early recovery with prognostic significance. Further, fluctuation is a required diagnostic criterion of delirium (acute confusion) and its prevalence and relevance in this patient sample supports the reconceptualization of early recovery suggested by Stuss and colleagues (1999).