Comorbid Traumatic Brain Injury and Spinal Cord Injury: Screening Validity and Effect on Outcomes

Published:April 12, 2016DOI:



      To determine the diagnostic accuracy of a self-report measure of traumatic brain injury (TBI) in people with spinal cord injury (SCI), and to assess the potential effect of TBI on acute and postacute outcomes.


      Incident TBI as determined by self-report was compared with systematic medical records review by physicians blinded to self-reported TBI.


      Inpatient rehabilitation unit.


      From 155 consecutive admissions, participants (N=105; 73% men; mean age, 45.9y; 73% white; 58% with tetraplegia) who met inclusion criteria and were admitted on the day of injury were recruited and assessed.


      Not applicable.

      Main Outcome Measure

      Step 2 of the Traumatic Brain Injury-4 (TBI-4) interview was used to estimate the presence and severity of TBI.


      Estimated incidence of TBI was 33% by chart review and 60% based on Step 2 of the TBI-4. Ninety-one percent of those with TBI based on chart review sustained mild injuries. At the optimal cutoff of “possible TBI,” the TBI-4 had a sensitivity of 83% (95% confidence interval, 66%–93%), a specificity of 51% (95% confidence interval, 39%–64%), and a Youden Index of 0.3 (95% confidence interval, 0.2–0.5). Compared with those without TBI, those with chart review–determined TBI had nonsignificant trends toward a longer acute care length of stay and a higher functional status at rehabilitation discharge, but equivalent 1-year outcomes.


      Step 2 of theTBI-4 did not meet Youden's criteria (≥0.8) for good diagnostic accuracy in the context of recent SCI. Comorbid TBIs were almost exclusively mild and not associated with poorer outcomes 1 year after SCI.


      List of abbreviations:

      CT (computed tomography), EMR (electronic medical record), GCS (Glasgow Coma Scale), LOC (loss of consciousness), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), TBI (traumatic brain injury), TBI-4 (Traumatic Brain Injury-4)
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