title: Concomitant injuries and its influence on functional outcome after traumatic brain injury.
abstract: OBJECTIVE
  This study aims to describe the presence and severity of extracranial concomitant injuries in traumatic brain injury (TBI) patients and to ascertain their effect on long-term functional outcome.
  
  
  METHODS
  A retrospective cohort study was performed in a single-center recruiting patients with first episode of TBI. The types and severity of extracranial concomitant injuries were documented for patients who fulfilled the inclusion criteria. Injuries with Abbreviated Injury Scale (AIS) grade 3-6 were considered to be high grade. A cross-sectional functional assessment was conducted at 18 months post-injury using Glasgow Outcome Scale.
  
  
  RESULTS
  A total of 100 patients were included in the analysis. Extracranial concomitant injuries were seen in 78% of the patients. Three commonest injuries were facial (44%), lower extremity (20%) and upper extremity (12%) injuries. Among the AIS grade ≥ 3, injury involving the chest was most common (41%). Presence of extracranial concomitant injuries AIS grade ≥ 3 was significantly associated with disability in TBI patients at 18 months (OR 12.74, 95% CI 2.39-67.95, p = 0.003).
  
  
  CONCLUSIONS
  Presence of extracranial concomitant injuries was high. In TBI survivors, extracranial concomitant injuries AIS grade ≥ 3 influenced the long-term functional outcome at 18 months, causing moderate and severe disabilities.
  
  
  CONCLUSIONS
  Concomitant injuries should be suspected in patients with traumatic brain injury, especially in a high-speed trauma mechanisms as the incidence can be as high as 78% as in this study and may interfere with the long term rehabilitation and outcome. This study shows that severe extra cranial concomitant injuries are associated with a poor long term functional outcome even in the mild traumatic brain injury patients and therefore need to be addressed early in the rehabilitation of this group of patients. Early diagnosis and management of severe concomitant injuries is warranted and may improve the functional gains in the long term after traumatic brain injury.
authors.affiliation: Department of Rehabilitation Medicine, Hospital Sultan Ismail, Johor Bahru, Malaysia.
authors.forename: Be Kim
authors.initials: BK
authors.lastname: Leong
authors.forename: Mazlina
authors.initials: M
authors.lastname: Mazlan
authors.forename: Rameezan Begam
authors.initials: RB
authors.lastname: Abd Rahim
authors.forename: Dharmendra
authors.initials: D
authors.lastname: Ganesan
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D001134:Arm Injuries / Q000453:epidemiology / Q000534:rehabilitation; D001930:Brain Injuries / Q000453:epidemiology* / Q000534:rehabilitation; D003430:Cross-Sectional Studies; D005151:Facial Injuries / Q000453:epidemiology / Q000534:rehabilitation; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007869:Leg Injuries / Q000453:epidemiology / Q000534:rehabilitation; D016015:Logistic Models; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology* / Q000534:rehabilitation; D015995:Prevalence; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult