Occupational categories and return to work after traumatic brain injury: a multicenter study

OBJECTIVE: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI), with focus on the relation between preinjury occupational category and RTW outcome. DESIGN: Prospective collaborative cohort study. SETTING: Seventeen National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems. PARTICIPANTS: Consecutive sample of 1341 patients (age range, 18-62y) who were hospitalized with a TBI diagnosis, received both acute neurotrauma services and inpatient rehabilitation services, consented to participate, were employed before injury, and completed a 1-year follow-up assessment. INTERVENTION: An inpatient interdisciplinary brain injury rehabilitation program. MAIN OUTCOME MEASURE: Competitive employment at 1 year postinjury. RESULTS: Participants were categorized into 1 of 3 groups depending on preinjury occupational title: professional/managerial (n=192), skilled (n=751), or manual labor (n=398). Chi-square analyses were computed to examine changes across occupation groups between preinjury occupation group and postinjury RTW. The rate of successful RTW was greatest for professional/managerial (56%), lower for skilled (40%), and lowest for manual labor (32%), yielding an odds ratio of 2.959 between the highest and lowest groups. Of those with successful RTW, most did so within the same occupational category grouping. A multiple logistic regression showed that preinjury occupation, education level, discharge FIM score, age, sex, marital status, and hospital length of stay each influenced RTW. CONCLUSIONS: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. A related hypothesis, that occupational classification also influences RTW outcome, has been understudied and has yielded conflicting results. The current study shows convincingly that the type of occupation influences RTW outcome, with the best prospect for RTW among people with professional/managerial jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.     

A medical/vocational case coordination system for persons with brain injury: an evaluation of employment outcomes

OBJECTIVE: To evaluate initial placement and 1-year employment outcomes of a Medical/Vocational Case Coordination System (MVCCS) for persons with brain injury (BI) that provides: (1) early case identification and coordination, (2) appropriate medical and vocational rehabilitation interventions, (3) work trials, and (4) supported employment interventions including job coaching. PARTICIPANTS: One hundred fourteen Minnesota residents, ages 18 to 65 years, with acquired BI. MAIN OUTCOME MEASURES: Outcome: Five levels of Vocational Independence Scale (VIS). Predictor: Preinjury employment status (VIS) and years of education, severity of initial injury, time since injury, current impairment/disability as measured by the Rasch-analyzed Staff Mayo-Portland Adaptability Inventory (MPAI), and impaired self-awareness measured by staff rating and the difference between Staff MPAI and Survivor MPAI. RESULTS: At placement, 46% in independent work; 25% in transitional placements; 9% in long-term supported employment; 10% in sheltered work; and 10% not placed. At 1-year follow-up (n = 101), 53% in independent work; 19% in transitional placement; 9% in supported work; 6% in sheltered work; and 13% unemployed. Regression analyses showed time since injury and Rasch Staff MPAI predicted VIS at placement; only VIS at placement independently predicted VIS at 1-year follow-up; Rasch Staff MPAI and preinjury education level predicted time to placement. CONCLUSIONS: The MVCCS optimized vocational outcome after BI. Time since injury and impairment/disability best predicted vocational placement. Level of initial placement best predicted employment status at follow-up. Persons with greater disability required more extended time and more extensive rehabilitation services before placement.     

Relating mental health and physical function at discharge to rehabilitation status at three months postburn

Preinjury mental health is said to be a major predictive factor in the rehabilitation progress of burn patients. However, it is unclear which component of rehabilitation (emotional v physical) is predicted by this variable; furthermore, the predictive validity of preinjury mental health has not been compared with physical variables. The present study compared preinjury mental health, physical variables, and length of hospitalization in predicting the rehabilitation progress of 59 major burn patients at three-month follow-up. Preinjury mental health was assessed by the Rand Mental Health Form; physical status, by the Upper Extremity Index (standard measures of upper limb joint mobility); and hospital stay, by the number of days of acute hospitalization. These variables were assessed at the time of discharge. Three-month rehabilitation outcome was measured by the Sickness Impact Profile, a self-report inventory that evaluates patient outcome in 12 different areas. These areas were in turn placed in the categories of disability (ie, difficulties in functioning in activities of daily living; eating) handicap (ie, difficulties in functioning in general areas of living; employment) and mental health status. In predicting mental health status at three months, preinjury mental health was significantly correlated. In predicting physical disability, physical factors were found to be important. Conversely, physical status was not significantly related to mental health outcome, and preinjury mental health was not related to physical disability. The results indicate the importance of defining outcome when attempting to predict rehabilitation progress of burn patients.     

Preinjury predictors of life satisfaction at 1 year after traumatic brain injury

Davis LC, Sherer M, Sander AM, Bogner JA, Corrigan JD, Dijkers MP, Hanks RA, Bergquist TF, Seel RT. Preinjury predictors of life satisfaction at 1 year after traumatic brain injury.ObjectiveTo investigate the predictive value of preinjury factors for satisfaction with life (SWL) at 1-year posttraumatic brain injury (TBI).DesignSecondary analysis of prospective, longitudinal registry using data collected during inpatient rehabilitation and at 1-year post-TBI.SettingFifteen specialized brain injury units providing acute rehabilitation care as part of the Traumatic Brain Injury Model Systems (TBIMS) program.ParticipantsCommunity-dwelling persons (N=444) with moderate to severe TBI aged 16 to 64 years enrolled in the TBIMS program between October 2007 and October 2008 with 1-year follow-up data.InterventionsNot applicable.Main Outcome MeasureSatisfaction With Life Scale (SWLS).ResultsHierarchical stepwise linear regression revealed that injury-related and demographic variables did not contribute significantly to the explained variance in SWLS scores. In contrast, the preinjury functioning (education, productivity/employment) and preinjury condition (psychiatric and substance use problems, severe sensory dysfunction, learning problems, prior TBI) blocks each contributed significantly to the explained variance in SWLS scores. Preinjury functioning accounted for 2.9% of the variance and preinjury conditions for 3.8%.ConclusionsAlthough their contributions are small, preinjury functioning and preinjury conditions are important to consider in the prediction of SWL post-TBI. Educational level and history of psychiatric and other premorbid difficulties are particularly important for clinicians to consider when implementing or developing interventions for persons with moderate to severe TBI.     

Abstract 24: Occupational categories and return to work after traumatic brain injury.

Objectives: To further evaluate determinants of return to work (RTW) after traumatic brain injury (TBI) by examining the relationship between preinjury occupational category and RTW outcome. Design: Prospective collaborative cohort study. Setting: To be eligible for this study, patients had to have been hospitalized with a diagnosis of TBI and have received both acute neurotrauma services and inpatient rehabilitation services at any of the 17 Traumatic Brain Injury Model Systems centers. Participants: Consecutive sample of 1173 patients with TBI who consented to participate, were employed prior to injury, and had completed 1-year follow-up assessment. Intervention: Included an inpatient interdisciplinary brain injury rehabilitation program. Main Outcome Measure: Competitive employment 1 year after rehabilitation. Results: Participants (N=1173) were categorized into 1 of 3 groups, depending on preinjury occupational title: high decision making (n=170), service related (n=622), or manual labor (n=381). Chi-square analysis showed an association between these categories and RTW at 1 year (P<.005). The chance of successful RTW was greatest for high decision making (58.8%), less for service related (42.8%), and lowest for manual labor (32.5%). Of those with successful RTW, the majority did so within the same occupational category grouping. Preinjury manual labor jobs were most likely to shift to a different category postinjury (39.1%), whereas service-related jobs were least likely to shift (25.5%). Conclusions: Prior research has shown that preinjury employment status (employed vs unemployed) greatly influences the odds of successful RTW after TBI. The current study convincingly demonstrates that the type of occupation also influences RTW outcome, with the best prospect for RTW being among persons with high decision-making jobs. Occupational category should be examined in the future development of predictive models for RTW after TBI.     

Employment after spinal cord injury.

The purpose of this study was to compare preinjury and postinjury employment rates in a diverse sample of persons with spinal cord injuries. Several employment variables were compared in individuals grouped into cohorts based on injury level, chronologic age, age at injury, time since injury, and years of education. The study sample (N = 286) was highly educated (mean = 14.2 years of education) and was an average of 18.6 years postinjury. Forty-eight percent of the participants were working at the time of the study, and 75% had worked at some time since injury. Only 12% of the persons who were employed at the time of injury returned to the same job after injury. Several noteworthy findings among the groups were: (1) participants with paraplegia were more likely than those with quadriplegia to return to their preinjury jobs; (2) employment rates were dramatically lower in the 51- to 60-year group; (3) more than 85% of persons in the cohorts who were at least 21 years postinjury had worked at some time since injury; (4) younger age at injury was associated with higher current employment rates; and (5) nearly 95% of all participants with 16 or more years of education had worked at some point since injury. The study results reaffirmed the need for comprehensive rehabilitation, identified the need for retraining several years after injury, and pointed to the role of higher education in producing high employment rates.     

Early cognitive status and productivity outcome after traumatic brain injury: findings from the TBI model systems

OBJECTIVE: To evaluate the contribution of early cognitive assessment to the prediction of productivity outcome after traumatic brain injury (TBI) adjusted for severity of injury, demographic factors, and preinjury employment status. DESIGN: Inception cohort. SETTING: Six inpatient brain injury rehabilitation programs. PARTICIPANTS: A total of 388 adults with TBI whose posttraumatic amnesia (PTA) resolved before discharge from inpatient rehabilitation. INTERVENTIONS: Administered neuropsychologic tests during inpatient stay on emergence from PTA. Follow-up interview and evaluation. Predictor measures also determined. MAIN OUTCOME MEASURE: Productivity status at follow-up 12 months postinjury. RESULTS: Multiple logistic regression analysis revealed that preinjury productivity status, duration of PTA, education level, and early cognitive status each made significant, independent contributions to the prediction of productivity status at follow-up. When adjusted for all other predictors, persons scoring at the 75th percentile on early cognitive status (less impaired) had 1.61 times greater odds (95% confidence interval [CI], 1.07-2.41) of being productive follow-up than those scoring at the 25th percentile (more impaired). Without adjustment, persons scoring at the 75th percentile had 2.46 times greater odds (95% CI, 1.77-3.43) of being productive at follow-up. CONCLUSIONS: Findings support the utility of early cognitive assessment by using neuropsychologic tests. In addition to other benefits, early cognitive assessment makes an independent contribution to prediction of late outcome. Findings support the clinical practice of performing initial neuropsychologic evaluations after resolution of PTA.     

Depression as a Predictor of Long-term Employment Outcomes Among Individuals With Moderate-to-Severe Traumatic Brain Injury

ObjectiveTo examine the predictive ability of depression when considering long-term employment outcomes for individuals with moderate-to-severe traumatic brain injury (TBI) after controlling for key preinjury and injury-related variables.DesignSecondary data analysis.SettingCommunity follow-up after discharge from an inpatient rehabilitation center.ParticipantsIndividuals between 18 and 60 years old with moderate-to-severe TBI enrolled in the Traumatic Brain Injury Model Systems database.InterventionsNot applicable.Main Outcome MeasuresEmployment status.ResultsThe prevalence of employment at 2 and 5 years post injury was 40.3% and 44.5%, respectively. Individuals identified as depressed at 1 year were more likely to be unemployed at 2 years post injury (odds ratio [OR], 1.77; 95% CI, 1.38-2.27; P<.0001). Similar relations between current depression and future employment were observed from 1- and 2-year depression status predicting 5-year employment (1-year: OR, 1.88; 95% CI, 1.48-2.40; P<.0001: 2-year: OR, 1.72; 95% CI, 1.36-2.17; P<.0001).ConclusionsAfter controlling for baseline predictors variables, the experience of postinjury depression—a modifiable condition—contributes predictive ability to future employment outcomes. Incorporating assessments and/or interventions for depression into postacute rehabilitation programs could promote favorable employment outcomes after TBI.     

A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury

Grauwmeijer E, Heijenbrok-Kal MH, Haitsma IK, Ribbers GM. A prospective study on employment outcome 3 years after moderate to severe traumatic brain injury.ObjectivesTo evaluate the employment outcome in patients with moderate to severe traumatic brain injury (TBI) and to identify which patients are at risk of unemployment 3 years after injury.DesignProspective cohort study.SettingPatients with moderate and severe TBI discharged from the neurosurgery departments of 3 level 1 trauma centers in The Netherlands.ParticipantsPatients aged 18 to 65 years (N=113; mean age ± SD, 33.2±13.1y; 73% men) who were hospitalized with moderate (26% of patients) to severe (74% of patients) TBI.InterventionsNot applicable.Main Outcome MeasuresThe main outcome measure was employment status. Potential predictors included patient characteristics, injury severity factors, functional outcome measured at discharge from the acute hospital with the Glasgow Outcome Scale (GOS), Barthel Index (BI), and FIM, and cognitive functioning measured with the Functional Assessment Measure (FAM).ResultsNinety-four patients (83%) completed the 3-year follow-up. The employment rate dropped from 80% preinjury to 15% at 3 months postinjury and gradually increased to 55% after 3 years. The employment rate significantly increased from 3 months up to 1 year, but it did not change significantly from 1 to 3 years postinjury. Age, length of hospital stay, discharge to a nursing home (vs home), psychiatric symptoms, and BI, GOS, FIM, and FAM scores were found to be significant univariate determinants for employment status. By using multiple logistic regression analysis, the FAM score (adjusted odds ratio 1.1; P<.000) and psychiatric symptoms (adjusted odds ratio .08; P<.019) were selected as independent predictors for employment status. A FAM cutoff score of less than 65 to identify patients at risk of long-term unemployment had a good diagnostic value.ConclusionsPatients with TBI with psychiatric symptoms and impaired cognitive functioning at hospital discharge are at the highest risk of long-term unemployment. These factors should be the focus of vocational rehabilitation.     

Outcome after traumatic brain injury: effects of aging on recovery

OBJECTIVE: To identify differences in outcome after traumatic brain injury (TBI) compared with orthopedic injuries as a function of age. DESIGN: Longitudinal data analyses from an inception cohort. SETTING: Outpatient rehabilitation program. PARTICIPANTS: Eighty-two orthopedic injury patients and 195 TBI patients. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Independent living, employment, and level of functioning 1 to 2 years after injury. RESULTS: Older patients and those with TBI were more likely to have increased dependence postinjury. Older TBI patients were more likely to have changes in employment status compared with orthopedic injury patients younger or TBI. The Mayo-Portland Adaptability Inventory and Disability Rating Scale were moderately predictive of level of functioning, return to employment, and independent living status 1 to 2 years postinjury. Injury severity was only mildly predictive of outcome. CONCLUSIONS: The effect of age on outcome affects recovery from neurologic injuries and, to a lesser extent, orthopedic injuries. Outcome after TBI is best predicted by patients' age and estimates of level of function at discharge. Findings suggest that older patients and those with TBI have a greater likelihood of becoming physically and financially dependent on others. Rehabilitation efforts should focus on maximizing levels of independence to limit financial and emotional costs to patients and their families.     

Functional outcomes from inpatient rehabilitation after traumatic brain injury: how do Hispanics fare?

OBJECTIVE: To examine the relation between Hispanic ethnicity and rehabilitation outcome in traumatic brain injury (TBI) survivors. DESIGN: Retrospective study. SETTING: Longitudinal dataset of the Traumatic Brain Injury Model Systems national database. PARTICIPANTS: Persons (N=3056; 2745 whites vs 311 Hispanics) with moderate to severe TBI hospitalized between 1989 and 2003. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Functional outcomes at discharge and 1-year follow-up (Disability Rating Scale [DRS], FIM instrument). Glasgow Outcome Scale-Extended (GOS-E), and the Community Integration Questionnaire (CIQ) were measured at follow-up only. RESULTS: At admission, Hispanics were less educated (P相似文献   

Racial Differences in Employment Outcome After Traumatic Brain Injury at 1, 2, and 5 Years Postinjury

Gary KW, Arango-Lasprilla JC, Ketchum JM, Kreutzer JS, Copolillo A, Novack TA, Jha A. Racial differences in employment outcome after traumatic brain injury at 1, 2, and 5 years postinjury.

Objectives

To examine racial differences in competitive employment outcomes at 1, 2, and 5 years after traumatic brain injury (TBI) and to determine whether changes in not competitive employment rates over time differ between blacks and whites with TBI after adjusting for demographic and injury characteristics.

Design

Retrospective cohort study.

Setting

Sixteen TBI Model System Centers.

Participants

Blacks (n=615) and whites (n=1407) with moderate to severe TBI.

Interventions

Not applicable.

Main Outcome Measure

Employment status dichotomized as competitively employed versus not competitively employed.

Results

After adjusting for demographic and injury characteristics, repeated-measures logistic regression indicated that (1) the odds of not being competitively employed were significantly greater for blacks than whites regardless of the follow-up year (all P<.001); (2) the odds of not being competitively employed declined significantly over time for each race (P≤.004); and (3) changes over time in the odds of not being competitively employed versus being competitively employed were not different between blacks and whites (P=.070). In addition, age, discharge FIM and Disability Rating Scale, length of stay in acute and rehabilitation, preinjury employment, sex, education, marital status, and cause of injury were significant predictors of employment status postinjury.

Conclusions

Short- and long-term employment is not favorable for people with TBI regardless of race; however, blacks fare worse in employment outcomes compared with whites. Rehabilitation professionals should work to improve return to work for all persons with TBI, with special emphasis on addressing specific needs of blacks.     

Poster 17: Functional outcome for asian americans at a traumatic brain injury model systems center

Objective: To compare the demographics and functional outcome for Asian Americans and whites treated at a Traumatic Brain Injury Model Systems (TBIMS) center. Design: Prospective, single-center trial. Participants: 30 Asian Americans and 133 whites admitted to a TBIMS center between February 1989 and July 2000. Subjects had to meet all the criteria to be entered into the Traumatic Brain Injury National Database. Interventions: Not applicable. Main Outcome Measures: All information was collected at the time of acute admission as well as at rehabilitation admission and discharge. Demographic data (gender, age), preinjury characteristics (prior employment, level of education, drug use), Glasgow Coma Scale (GCS), and outcome scales (Disability Rating Scale [DRS], FIM™ instrument) were obtained. Results: Most Asians (67%) and whites (74%) were men. More Asians were either students (20% vs 7%) or homemakers (10% vs 1%) preinjury. The average age at the time of injury was 30.7 years for Asians and 39.3 years for whites. Average admission GCS score was 9.1 for Asians and 10.5 for whites. Prior traumatic brain injury (TBI) requiring hospitalization was 7% for Asians and 21% for whites. The mean DRS change score ± SD was 8.5±4.5 for Asians and 6.8±4.3 for whites. Conclusion: Preinjury employment status differed between Asians and whites, with more Asians being students or homemakers. The history of TBI was significantly lower for Asians than whites. Asians were generally younger at the time of injury. DRS change was slightly better for Asians. There were no other statistically significant differences between both groups in DRS or FIM scores.     

A comparison of acute and postdischarge predictors of employment 2 years after traumatic brain injury

OBJECTIVE: To examine whether adding postdischarge psychosocial predictors to premorbid and injury-related variables improved the capacity to predict employment 2 years after rehabilitation for traumatic brain injury (TBI). DESIGN: Data were collected prospectively at 6 and 24 months after discharge from rehabilitation. Logistic regression analyses examined predictors of employment status. SETTING: Inpatient and community TBI rehabilitation service attached to a major Australian teaching hospital. PARTICIPANTS: Fifty-five patients with TBI, aged 16 or older, who were consecutively admitted to a brain injury unit with complete longitudinal data and who agreed to participate in the study. INTERVENTION: Measured injury severity (Glasgow Coma Scale scores, posttraumatic amnesia); functional independence (Functional Assessment Measure cognitive subscale) at admission and discharge from rehabilitation; self-report of employment (premorbid, postdischarge); postdischarge psychosocial status at 6 months and 2 years (Community Integration Questionnaire, General Health Questionnaire, Trauma Complaints List, Overt Aggression Scale, Alcohol Use Disorders Inventory Test, Satisfaction with Life Scale). MAIN OUTCOME MEASURES: Employment status (employed, unemployed) was used to reflect vocational outcome. Predictor variables comprised premorbid work status, injury-related variables (age, injury severity), and postdischarge variables (employment, community integration, psychologic, cognitive status). RESULTS: Adding postdischarge predictors to premorbid and acute variables significantly improved the ability to predict work status 2 years after rehabilitation. Age at the time of injury, premorbid employment status, work status, and psychologic distress 6 months postdischarge were significant predictors of employment. CONCLUSIONS: It is important to consider postdischarge psychologic well-being, in conjunction with premorbid and acute factors, in vocational interventions after TBI.     

Racial differences in employment outcomes after traumatic brain injury

Arango-Lasprilla JC, Ketchum JM, Williams K, Kreutzer JS, Marquez de la Plata CD, O'Neil-Pirozzi TM, Wehman P. Racial differences in employment outcomes after traumatic brain injury.

Objective

To examine racial differences in employment status and occupational status 1 year after a traumatic brain injury (TBI).

Design

Retrospective study.

Setting

Longitudinal dataset of the Traumatic Brain Injury Model Systems national database.

Participants

Subjects with primarily moderate to severe TBI (3468 whites vs 1791 minorities) hospitalized between 1989 and 2005.

Interventions

Not applicable.

Main Outcome Measures

Employment status (competitively employed or unemployed) and occupational status (professional/managerial, skilled, or manual labor) at 1 year postinjury.

Results

Race and/or ethnicity has a significant effect on employment status at 1 year postinjury (=58.23, P<.001), after adjusting for preinjury employment status, sex, Disability Rating Scale at discharge, marital status, cause of injury, age, and education. The adjusted odds of being unemployed versus competitively employed are 2.17 times (95% confidence interval, 1.78-2.65) greater for minorities than for whites. Race and ethnicity does not have a significant effect on occupational status at 1 year postinjury.

Conclusions

With this empirical evidence supporting racial differences in employment outcomes between minorities and whites at 1 year postinjury, priority should be given to tailoring interventions to maximize minority survivors' work-related productivity.     

Years to employment after spinal cord injury

OBJECTIVE: To identify factors related to the length of time between spinal cord injury (SCI) onset and return to work among 259 participants with SCI, all of whom have worked at some point since SCI onset. DESIGN: All data were cross-sectional and collected by survey methodology. SETTING: A midwestern university hospital and private hospital in the same metropolitan area. PARTICIPANTS: Participants were identified from outpatient records of 2 participating hospitals. They met 4 exclusion and inclusion criteria: (1) traumatic SCI; (2) 18 years of age or older; (3) a minimum of 2 years postinjury; and (4) had been employed at some time since SCI. The 259 participants' average age was 46.4 years at the time of the study, with an average of 23.5 years having passed since SCI onset. INTERVENTIONS: Not applicable. Main Outcome Measures: Years from injury onset to beginning first postinjury job, years to the first full-time postinjury job, and the Life Situation Questionnaire. RESULTS: Participants averaged 4.8 years from the time of SCI onset to their first postinjury job and 6.3 years until their first full-time postinjury job. However, these figures varied greatly depending on whether the individual returned to the preinjury job, was working as a professional at the time of injury, had a noncervical injury, and the amount of education by the time of injury. CONCLUSION: There are 2 general tracks to employment after SCI-a fast track where people return to their preinjury job or preinjury profession and a slower track that is generally associated with needs for further reeducation and training. Working to return the individual to the preinjury job or to a position related to their preinjury occupation may substantially shorten the interval to return to work. In cases where this is not possible, counselors must work with individuals to understand the timeline of return to work and identify realistic educational goals that fit both the individual's interest pattern and postinjury abilities.     

Outcome after traumatic brain injury: pathway analysis of contributions from premorbid, injury severity, and recovery variables

OBJECTIVE: To examine the relationship of premorbid variables, injury severity, and cognitive and functional status to outcome 1 year after traumatic brain injury (TBI) and to assess the feasibility of multivariate path analysis as a way to discover those relationships. DESIGN: Prospective, longitudinal. SETTINGS: Level I trauma center, acute inpatient rehabilitation hospital. PATIENTS: One hundred seven subjects (87 men, 20 women; mean age, 33.91 +/- 14.2 yr) who had experienced severe TBI, typically from motor vehicle crashes. INTERVENTIONS: Acute medical and rehabilitation care. MAIN OUTCOME MEASURES: Disability Rating Scale, Community Integration Questionnaire, and return to employment. Evaluated in acute rehabilitation, and at 6 and 12 months' postinjury. RESULTS: Path analyses revealed that premorbid factors had significant relationships with injury severity, functional skills, cognitive status, and outcome; injury severity affected cognitive and functional skills; and cognitive status influenced outcome. No significant relationships were found between injury severity and emotional status, injury severity and outcome, emotional status and outcome, and functional skills and outcome. CONCLUSIONS: Multivariate analysis is important to understanding outcome after TBI. Injury severity, as measured in this study, is less important to 12-month outcome than the premorbid status of the person and the difficulties (particularly cognitive deficits) exhibited at follow-up 6 months after the trauma.     

Effect of severity of post-traumatic confusion and its constituent symptoms on outcome after traumatic brain injury

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.     

Ethnographic analysis of traumatic brain injury patients in the national Model Systems database

OBJECTIVE: To compare demographics, injury characteristics, therapy service and intensity, and outcome in minority versus nonminority patients with traumatic brain injury (TBI). DESIGN: Retrospective analysis. SETTING: Twenty medical centers. PARTICIPANTS: Two thousand twenty patients (men, n=1,518; women, n=502; nonminority, n=1,168; minority, n=852) with TBI enrolled in the Traumatic Brain Injury Model Systems database. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Age, gender, marital status, education, employment status, injury severity (based on Glasgow Coma Scale [GCS] admission score, length of posttraumatic amnesia, duration of unconsciousness), intensity (hours) of therapy rendered, rehabilitation length of stay (LOS), rehabilitation charges, discharge disposition, postinjury employment status, FIM instrument change scores, and FIM efficiency scores. Independent sample t tests were used to analyze continuous variables; chi-square analyses were used to evaluate categorical data. RESULTS: Demographics: overall, minorities were found to be mostly young men who were single, unemployed, and less well educated, with a longer work week if employed when injured. Etiology: motor vehicle crashes (MVCs) predominated as the cause of injury for both groups; however, minorities were more likely to sustain injury from acts of violence and auto-versus-pedestrian crashes. Minorities also had higher GCS scores on admission and shorter LOS. Rehabilitation services: significant differences were found in the types and intensity of rehabilitation services provided; these included physical therapy, occupational therapy, and speech-language pathology, but not psychology. CONCLUSION: Minority patients who sustain TBI generally tend to be young men with less social responsibility. Although MVCs predominate as the primary etiology, acts of violence and auto-versus-pedestrian incidents are more common in the minority population. Minorities tend to have higher GCS scores at admission. Also, the type and intensity of rehabilitation services provided differed significantly for the various interdisciplinary subspecialties. Rehabilitation charges, discharge disposition, and postinjury employment status were similar for the 2 groups, even though LOS is typically 3 to 4 days shorter for the minority group. A more detailed investigation is warranted to explain these findings.