Multimodal early rehabilitation and predictors of outcome in survivors of severe traumatic brain injury.
BACKGROUND
To determine the effect of brain lesion pattern on early recovery after severe traumatic brain injury (TBI).


METHODS
In a setting of a multimodal early rehabilitation unit at a level I trauma center, 135 consecutive survivors of severe TBI (mean age, 40 years, 25% women) were studied prospectively. Assessment of disability was performed weekly using an extended Barthel Index (eBI) ranging from -325 to +100 points. Clinical and brain morphologic variables were tested in multivariate logistic regression models to determine predictors of outcome.


RESULTS
Imaging revealed cerebral contusion in 115 patients (85%) affecting the frontal (n = 80), temporal (n = 62), parieto-occipital (n = 17), brain stem (n = 13), and cerebellar (n = 5) regions. In addition, 80 patients (59%) showed diffuse brain edema, 75 (55%) subarachnoid, 37 (28%) subdural, and 18 (13%) epidural hemorrhage. After a mean stay of 72 +/- 51 days in the early rehabilitation unit, one patient died, 40 (30%) revealed good outcome (median eBI, +55), and a further 43 patients (32%) showed excellent outcomes (eBI, 90-100). Temporal (odds ratio 2.6; 95% confidence interval 1.1-6.5) and brain stem contusions (odds ratio 13.8; 95% confidence interval 3.0-64.1) were independent predictors of poor outcome.


CONCLUSIONS
Temporal and brain stem contusions constitute independent risk factors for poor outcome in survivors of severe TBI. The results further suggest a high potential for multimodal early rehabilitation after severe TBI.
Choi
Jae H
JH
Department of Neurology, BG Kliniken Bergmannstrost, Halle, Germany. jchoi@neuro.columbia.edu
Jakob
Michael
M
Stapf
Christian
C
Marshall
Randolph S
RS
Hartmann
Andreas
A
Mast
Henning
H
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation*; D001933:Brain Stem / Q000293:injuries; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020127:Recovery of Function; D017741:Survivors; D013702:Temporal Lobe / Q000293:injuries; D013997:Time Factors