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Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay

OBJECTIVES: To report occurrence and identify patient's features and risk factors
of heterotopic ossifications in patients with severe acquired brain injury in
intensive rehabilitation centres. DESIGN: Multicentre cross-sectional survey.
SETTING: A total of 48 severe acquired brain injury rehabilitation institutes.
PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N =
689) in rehabilitation centres on 28 May 2016. MAIN OUTCOME MEASURE: Occurrence
of heterotopic ossifications diagnosed by standard radiological and/or
sonographic evaluation on the basis of clinical suspicion. RESULTS: Heterotopic
ossification occurred around one or more joints in 94/689 patients (13.6%) with a
significantly higher prevalence in young males. Occurrence did not significantly
differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular
and 11.5% other). Prevalence was significantly higher in patients with diffuse
(23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%;
chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and
ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6%
versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7%
versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between
acute brain injury and admission to rehabilitation centre was significantly
associated with higher frequency of heterotopic ossifications. CONCLUSION:
Occurrence of heterotopic ossifications is frequent in patients with severe
traumatic and non-traumatic brain-injury in rehabilitation centres. Our study
confirms male gender, young age, paroxysmal sympathetic hyperactivity,
spasticity, longer duration of coma and ventilation and longer interval between
brain injury onset and admission to rehabilitation centre as possible risk
factors. Further studies are necessary to investigate the role of early
appropriate rehabilitation pathways to reduce occurrence of heterotopic
ossifications.

Langue : ANGLAIS

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