Comorbid traumatic brain injury and spinal cord injury: Screening validity and effect on outcomes

Publication date: Available online 12 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Charles H. Bombardier, Darren C. Lee, Debbie L. Tan, Jason Barber, Jeanne M. Hoffman
ObjectiveTo 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 post-acute outcomes.DesignWe compared incident TBI as determined by self-report versus systematic medical records review by physicians blinded to self-reported TBI.SettingInpatient rehabilitation unitParticipants105 of 155 consecutive admissions met inclusion criteria, were admitted on the day of injury, and were assessed.Intervention(s)not applicableMain outcome measure(s)Step 2 of the TBI-4 interview was used to estimate the presence and severity of TBI.ResultsThe sample was 73% male, 45.9 years old on average, 73% Caucasian, and 58% had tetraplegia. Estimated incidence of TBI was 33% by chart review and 60% based on Step 2 of the TBI-4. 91% 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 (CI), 66-93%), specificity of 51% (95%CI, 39-64%), and Youden's index of 0.3 (95% CI, 0.2-0.5). Compared to those without TBI, those with chart review determined TBI had non-significant trends toward longer acute care length of stay and higher functional status at rehabilitation discharge, but equivalent one-year outcomes.ConclusionsStep 2 of theTBI-4 did not meet Youden's criteria (0.8 or higher) for good diagnostic accuracy in the context of recent SCI. Comorbid TBIs were almost exclusively mild and not associated with poorer outcomes one year after SCI.



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