Comparison of veterans affairs and NIDILRR traumatic brain injury model systems participants with disorders of consciousness.

OBJECTIVE: To characterize demographic, pre-injury, and outcome data within the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and Veterans Affairs (VA) Traumatic Brain Injury Model Systems (TBIMS) cohorts with severe traumatic brain injury (TBI) with no command-following ability at time of admission to acute rehabilitation. DESIGN: Retrospective cohort. SETTING: NIDILRR and VA TBI Model Systems (TBIMS) centers. PARTICIPANTS: 396 NIDILRR and 72 VA participants without command-following ability who experienced TBI with subsequent Disorder of Consciousness (DoC). MAIN OUTCOME MEASURE: Pre-injury and injury characteristics, rehabilitation outcomes, and 1-year self-reported outcomes. RESULTS: VA TBIMS cohort included individuals who were active duty or had military service before their injury. The VA cohort were more likely to be re-hospitalized at 1-year follow-up or residing in a long-term care or rehab setting. The NIDILRR TBIMS cohort had higher FIM and DRS scores at rehabilitation discharge, while the VA participants saw longer lengths of stay and higher numbers of "violent" injury types. CONCLUSIONS: This study allows for a better understanding of the comparability between VA and NIDILRR DoC cohorts providing guidance on how veteran and civilian samples might be merged in future TBIMS studies to explore predictors of recovery from a DoC.

Predicting emergence from a disorder of consciousness using the Coma Recovery Scale-Revised.

This study explored the utility of the Coma Recovery Scale-Revised (CRS-R) in predicting emergence from a disorder of consciousness, using a sample of veterans who were treated at one of the five Veterans Affairs (VA) polytrauma rehabilitation centre sites in an Emerging Consciousness programme. Participants (N = 70) included both combat and non-combat active duty military personnel and veterans who sustained either a severe traumatic brain injury, or anoxic brain injury and were considered to have a disorder of consciousness at the time of admission. Patient information was retrospectively collected from electronic medical records from one of the VA polytrauma rehabilitation centre sites. Receiver Operator Characteristic models were utilised to explore "cut-off scores" for predicting emergence using the CRS-R. Results showed that week-three scores on the CRS-R were more accurate in determining whether a veteran would emerge from a disorder of consciousness. Limitations, including a limited sample size are explored, along with implications and recommendations for future research and clinical practice.