Citation

Kumar RG, Olsen J, Juengst SB, Dams-Oʼconnor K, Oʼneil-Pirozzi TM, Hammond FM, Wagner AK. J. Head Trauma Rehabil. 2019; 34(4): 224-232.

Affiliation

Departments of Physical Medicine & Rehabilitation (Drs Kumar, Olsen, and Wagner) and Epidemiology (Dr Kumar), Clinical and Translational Science Institute, Center for Neuroscience, and Safar Center for Resuscitation Research (Dr Wagner), University of Pittsburgh, Pennsylvania; Departments of Physical Medicine and Rehabilitation (Dr Juengst) and Rehabilitation Counseling (Dr Juengst), UT Southwestern, Dallas, Texas; Department of Rehabilitation and Human Performance and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond).

Copyright

(Copyright © 2019, Lippincott Williams and Wilkins)

DOI

10.1097/HTR.0000000000000470

PMID

30829819

Abstract

OBJECTIVES: To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI).

DESIGN: Prospective cohort study. PARTICIPANTS: Adults 50 years and older with moderate-to-severe TBI (n = 2134). MEASURES: Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale-Extended (GOS-E) at 1 year).

RESULTS: Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization.

CONCLUSION: Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.

Language: en