title: Medical comorbidities in disorders of consciousness patients and their association with functional outcomes.
abstract: OBJECTIVE
  To identify, for patients in states of seriously impaired consciousness, comorbid conditions present during inpatient rehabilitation and their association with function at 1 year.
  
  
  METHODS
  Abstracted data from a prospective cross-sectional observational study with data collection occurring January 1996 through December 2007.
  
  
  METHODS
  Four inpatient rehabilitation facilities in metropolitan areas.
  
  
  METHODS
  The study sample of 68 participants is abstracted from a database of 157 patients remaining in states of seriously impaired consciousness for at least 28 days.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  One-year cognitive, motor, and total FIM score.
  
  
  RESULTS
  The most common medical complications during inpatient rehabilitation for the study sample are active seizures (46%), spasticity (57%), urinary tract infections (47%), and hydrocephalus with and without shunt (38%). Presence of ≥3 medical complications during inpatient rehabilitation, controlling for injury severity, is significantly (P<.05) associated with poorer total FIM and FIM motor scores 1 year after injury. The presence of hydrocephalus with and without shunt (r=-.20, -.21, -.18; P ≤.15), active seizures (r=-.31, -.22, -.42), spasticity (r=-.38, -.28, -.40), and urinary tract infections (r=-.25, -.24, -.26) were significantly (P<.10) associated with total FIM, FIM cognitive, and FIM motor scores, respectively.
  
  
  CONCLUSIONS
  Reported findings indicate that persons in states of seriously impaired consciousness with higher numbers of medical complications during inpatient rehabilitation are more likely to have lower functional levels 1-year postinjury. The findings indicate that persons with ≥3 medical complications during inpatient rehabilitation are at a higher risk for poorer functional outcomes at 1 year. It is, therefore, prudent to evaluate these patients for indications of these complications during inpatient rehabilitation.
authors.affiliation: Department of Veterans Affairs, Research Service and the Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr Veterans Affairs Hospital, Hines, IL; Physical Medicine and Rehabilitation Service, Edward Hines Jr Veterans Affairs Hospital, Hines, IL.
authors.forename: Shanti
authors.initials: S
authors.lastname: Ganesh
authors.forename: Ann
authors.initials: A
authors.lastname: Guernon
authors.forename: Laura
authors.initials: L
authors.lastname: Chalcraft
authors.forename: Brett
authors.initials: B
authors.lastname: Harton
authors.forename: Bridget
authors.initials: B
authors.lastname: Smith
authors.forename: Theresa
authors.initials: T
authors.lastname: Louise-Bender Pape
mesh_terms: D000328:Adult; D000367:Age Factors; D001930:Brain Injuries / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D003244:Consciousness Disorders / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: BI; Brain injuries; Comorbidity; Consciousness disorders; PTE; Rehabilitation; SMR; TBI; UTI; brain injury; posttraumatic epilepsy; standard mortality ratio; traumatic brain injury; urinary tract infection