Article

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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS