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.
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Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI.
“Early rehabilitation in the acute and subacute phase may be a critical period and a key to effective rehabilitation, especially in TBI [9].”
From A Cloud-Based Virtual Reality App for a Novel Telemindfulness Service: Rationale, Design and Feasibility Evaluation (2017) · cites this paper as [9]
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- Authors
- Choi, J. H., Jakob, M., Stapf, C., Marshall, R. S., Hartmann, A., & Mast, H.
- Affiliations
- BG Klinikum Bergmannstrost Halle (DE)
- Columbia University Irving Medical Center (US)
- Venue
- Journal of Trauma: Injury, Infection & Critical Care
- Published
- 2008-11
- Volume
- 65
- Issue
- 5
- Pages
- 1028-1035
- ISSN
- 0022-5282 (ISSN-L)
- OpenAlex
- W2048190605
- Cited by
- 48
- References
- 29
- Citations by year
- 2025: 1 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 8 · 2016: 5 · 2015: 2 · 2014: 4 · 2013: 6 · 2012: 1
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Keywords
- severe traumatic brain injury, cerebral contusion, prognostic factors, functional disability, subarachnoid hemorrhage, subdural hematoma, epidural hematoma
- MeSH terms
- Adult, Aged, Brain Injuries, Brain Stem, Female, Humans, Male, Middle Aged, Prospective Studies, Temporal Lobe, Time Factors, Outcome Assessment, Health Care, Survivors, Recovery of Function
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