title: Multimodal early rehabilitation and predictors of outcome in survivors of severe traumatic brain injury.
abstract: 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.
authors.affiliation: Department of Neurology, BG Kliniken Bergmannstrost, Halle, Germany. jchoi@neuro.columbia.edu
authors.forename: Jae H
authors.initials: JH
authors.lastname: Choi
authors.forename: Michael
authors.initials: M
authors.lastname: Jakob
authors.forename: Christian
authors.initials: C
authors.lastname: Stapf
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.forename: Andreas
authors.initials: A
authors.lastname: Hartmann
authors.forename: Henning
authors.initials: H
authors.lastname: Mast
mesh_terms: 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