Does neurologic examination during inpatient rehabilitation help predict global outcome after nonpenetrating traumatic brain injury?

Abstract

Objective: To determine whether combining basic neurologic examination measurements with posttraumatic amnesia (PTA) duration can enhance prediction accuracy in moderate-to-severe traumatic brain injury (TBI).

Design: A descriptive between-subjects study.

Setting: Multicenter: 4 Veterans Affairs Brain Injury Rehabilitation Centers within the Defense and Veterans Brain Injury Center network.

Participants: A total of 210 patients (active duty, veteran, or military dependent) with moderate-to-severe nonpenetrating TBI who consented during acute rehabilitation for data collection and completed relevant baseline and 12-month follow-up evaluations.

Methods: Multivariate analysis on neurologic examination predictor variables (upper extremity paresis, lower extremity paresis, Romberg test, and Kurtzke Expanded Disability Status Scale [EDSS]) was performed with block logistic regression modeling that controlled for duration of PTA.

Main outcome measure: Glasgow Outcome Score at 1 year.

Results: Glasgow Outcome Score prediction accuracy by using PTA duration was modestly improved with the included neurologic examination measurements. The most influential predictor among them was EDSS, a composite measurement of neurologic impairment. When EDSS was excluded, the simple measurements of upper limb paresis and the Romberg test also provided independent prognostic value.

Conclusions: This study demonstrated that simple clinical measurements of neurologic impairment (limb paresis, imbalance, other neurologic deficits) are of value in refining the prediction of long-term global outcome from TBI. These measurements may serve as markers of focal injury not captured by PTA duration, a severity marker weighted toward diffuse injury.