Abstract
Objectives
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.
Design
Incident TBI as determined by self-report was compared with systematic medical records
review by physicians blinded to self-reported TBI.
Setting
Inpatient rehabilitation unit.
Participants
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.
Interventions
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.
Results
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.
Conclusions
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.
Keywords
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: April 12, 2016
Footnotes
Supported by the Department of Education, National Institute on Disability, Independent Living, and Rehabilitation Research, Spinal Cord Injury Model Systems: University of Washington (grant nos. H133N060033; H133N110009).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
