Pre-injury psychiatric history, subacute symptoms and personality traits predict social reintegration at 3-month post-mild traumatic brain injury.

BACKGROUND: The purpose of the study was to identify whether the presence of a pre-injury psychiatric history, subacute post-concussive symptoms (PCS) and personality traits were predictive of less favorable social reintegration for 3 months following a mild traumatic brain injury (mTBI). METHOD: A total of 76 patients with mTBI were included, and the presence of a pre-injury psychiatric history was identified from the medical chart. One-month post-accident, these patients completed the Millon Multiaxial Clinical Inventory, 3rd Edition assessing personality traits and the Rivermead Post-Concussion Symptoms Questionnaire to measure subacute PCS. Social reintegration was measured using the Mayo-Portland Adaptability Inventory, 4th Edition at 3-month post-accident. RESULTS: The presence of pre-injury psychiatric history, high levels of subacute PCS and Cluster B personality traits such as histrionic and borderline features were significant predictors of social reintegration quality at 3-month post injury. CONCLUSION: This study provides new insights on cluster B personality traits and its influence on recovery and social reintegration at 3-month post mTBI.

Identifying prioritization criteria for patients with mtbi waiting for multidisciplinary rehabilitation services: A Delphi study.

INTRODUCTION: Rehabilitation service providers must take into account prognostic factors when making clinical decisions, which includes using these factors as prioritization criteria. The goal of this study was to establish consensus on patient prioritization criteria based on prognostic factors related to persistent symptoms for patients with mild traumatic brain injury (mTBI) waiting for outpatient specialized rehabilitation services. MATERIALS AND METHODS: We conducted a Delphi survey involving clinicians, researchers, decision makers, and patients. Before the survey, we presented the results of an overview of systematic reviews summarizing the evidence on prognostic factors related to post-concussion symptoms. RESULTS: After two rounds, the 17 experts reached consensus on the inclusion of 12 prioritization criteria: acute stress disorder, anxiety and depression, baseline mental and physical health, functional impacts and difficulties in performing daily habits after the trauma, motivation to receive services, multiple concussions, prior neurological problems, PTSD, quality of sleep, return to work failures, somatic complaints, suicidal ideation. CONCLUSION: Healthcare stakeholders must consider a wide range of factors to guide clinical decision-making, including about access to care and patient prioritization. This study shows that the Delphi technique can be used to reach consensus on such decisions regarding patients with mTBI who are waiting for outpatient specialized rehabilitation services.

Risk Factors for Alzheimer Disease Development After Traumatic Brain Injury: A Preliminary Study.

Traumatic brain injury (TBI) is increasingly recognized as a major risk factor for developing neurocognitive disorders, though this association remains controversial. Determination of risk factors for post-traumatic neurodegeneration in patients with TBI is critical given the high incidence of TBI. We hypothesized that cardiovascular and metabolic comorbidities, in addition to TBI severity, are associated with the risk of post-traumatic development of Alzheimer disease dementia (ADD). A case-controlled retrospective study was conducted using medical records and medical insurance data of 5642 patients with TBI admitted to a tertiary trauma center over a 12-year period, to assess risk factors of developing ADD after TBI. Logistic regression shows that presence of post-traumatic amnesia ( P= 0.03) and chronic vascular lesions ( P= 0.04) are significantly associated with development of ADD after TBI. This innovative preliminary study is the first to explore risk factors for post-traumatic ADD. Further association studies are essential to optimize care following TBI.

Relationships between predisposing, precipitating, and perpetuating factors and executive functioning following mild traumatic brain injury.

INTRODUCTION: The aim of this study was to determine the sociodemographic and MTBI-related variables associated with executive functioning (EF). METHODS: Based on the theoretical model of Hou and colleagues, data on predisposing (age, education, premorbid IQ), precipitating (post-traumatic amnesia, loss of consciousness, presence of frontal lesions, post-accident time to evaluation) and perpetuating (anxious and depressive affects and post-concussive symptoms) factors were retrospectively collected from the medical records of 172 patients with MTBI. EF data based on the 3 processes included in Miyake's prediction model (2000) (updating, cognitive flexibility and inhibition) were collected using respectively the Digit span task of the Weschler - 4th edition, the Trails A and B as well as the initiation time on the Tower of London- Drexel University. RESULTS: Updating was significantly associated with education, premorbid IQ, age, anxiety, and depressive affect. Inhibition was associated with education and age. No variable was associated with cognitive flexibility. CONCLUSIONS: Following a MTBI, clinicians should consider that level of education and pre-morbid IQ may "predispose" patients to higher EF performances. They should also measure level of anxiety and depressive affect knowing that these may "perpetuate" some EF impairments (specifically the updating process).

Cognitive functioning following traumatic brain injury in older adults: associations with social participation and health-related quality of life.

OBJECTIVES: To describe objective and subjective cognitive functioning older adults who sustained TBI at age 65 or over, and to determine whether cognitive functioning is associated with health-related quality of life (HRQoL) and social participation. METHOD: The sample consisted of 40 individuals with TBI (mean age = 73 years; 65% mild, 35% moderate/severe TBI). On average 15 months post-injury, they completed measures of objective and subjective cognitive functioning (Telephone Interview for Cognitive Status-Modified, Alphaflex, Medical Outcomes Study Cognitive Functioning Scale), HRQoL (SF-12), and social participation (Participation Assessment with Recombined Tools - Objective). RESULTS: Mean score for objective cognitive functioning was lower than normative values, while mean scores for executive functioning and subjective cognitive functioning were comparable to normative values. There was no relationship between objective and subjective measures. Subjective cognitive functioning and (to a lesser extent) global objective cognitive functioning were significantly associated with mental HRQoL but not with physical HRQoL or social participation. CONCLUSION: These results underscore the importance of considering both subjective perception and objective performance when assessing and intervening on cognition to promote better mental HRQoL in older adults with TBI.

Multidimensional Psychoeducative and Counseling Intervention (SAAM) for Symptomatic Patients With Mild Traumatic Brain Injury: A Pilot Randomized Controlled Trial.

OBJECTIVE: To estimate feasibility and explore the treatment effect of a psychoeducative and counseling intervention program targeting 4 postconcussion symptoms (SAAM: Sleep/fatigue, Attention, Anxiety/mood, Memory). SETTING: Level 1 trauma center. PARTICIPANTS: Twenty-five patients with postconcussion symptoms enrolled 1 to 3 months post-accident. DESIGN: Parallel-group (experimental and wait-list control), randomized controlled trial, with masked outcome assessment the week following the last intervention session. The Experimental group received the SAAM intervention (1 session/week during 4 weeks); care as usual was maintained for both groups. MAIN MEASURE: Rivermead Post-concussion Symptoms Questionnaire (RPQ). SECONDARY MEASURES: Hospital Anxiety and Depression Scale (HADS-A/-D); Pittsburgh Sleep Quality Index (PSQI); Multidimensional Fatigue Inventory (MFI); attention and memory neuropsychological battery; Community Integration Questionnaire (CIQ). TOLERABILITY MEASURE: A 10-item satisfaction questionnaire for the experimental group. RESULTS: 15.67% of the participants evaluated for eligibility were randomized and completed the evaluation at T0. High rates of satisfaction regarding the SAAM intervention were found in the experimental group (n = 10). One participant (experimental group) withdrew after T0. Exploratory results showed that the group × time interaction was not significant, but had a large effect size for the RPQ (P = .051, η2 = .16) and HADS-D (P = .052, η2 = 0.17), and a significant interaction was found with a large effect size for the PSQI (P = .017, η2 = .24) and MFI (P = .041, η2 = .18). Post-hoc analyses revealed a significant reduction of these variables post-intervention. No significant group × time interaction was observed for cognitive measures and CIQ. CONCLUSION: The pilot study demonstrates the feasibility and tolerability of the SAAM intervention. Preliminary data suggest that SAAM intervention delivered post-acutely might reduce postconcussion symptoms, depression symptoms, fatigue, and sleep difficulties. A larger scale randomized control trial is warranted to confirm these promising results.

Persistent Postconcussion Symptoms: An Expert Consensus-Based Definition Using the Delphi Method.

OBJECTIVE: To provide an expert consensus definition of persistent postconcussion symptoms following a mild traumatic brain injury (mTBI). PARTICIPANTS: Canadian healthcare professionals caring for patients with mTBI. DESIGN: Online Delphi process. MAIN MEASURES: A first Delphi round documented important dimensions or criteria to consider when defining persistent symptoms. Expert opinions were then resubmitted in 4 subsequent Delphi rounds and their relevance was rated using a 9-point Likert scale. An item with a median rating of 7 or more and a sufficient level of agreement were considered consensual. RESULTS: After 5 rounds, consensus was reached on a set of criteria that can be summarized as follows: presence of any symptom that cannot be attributed to a preexisting condition and that appeared within hours of an mTBI, that is still present every day 3 months after the trauma, and that has an impact on at least one sphere of a person's life. CONCLUSION: This Delphi consensus proposes a set of criteria that support a more uniform definition of persistent symptoms in mild TBI among clinicians and researchers. This definition may help clinicians better identify persistent postconcussion symptoms and improve patient management.

Relationship between depression, community integration and life satisfaction following mild traumatic brain injury.

Purpose: Compared to studies on moderate and severe traumatic brain injury (TBI), less literature exists concerning the consequences of mild traumatic brain injury (mTBI) on community integration and life satisfaction, especially in the early phase of recovery. Moreover, a better understanding of the variables that contribute to community integration and life satisfaction is still needed. The aim of the study was to assess the association of mood, fatigue and post-concussive symptoms with community integration and life satisfaction early following mTBI.Research method: A total of 85 participants aged between 18 and 61 years who sustained mTBI were included. Participants answered web-based questionnaires measuring anxiety and depression symptoms, fatigue, post-concussive symptoms, community integration and life satisfaction in the first three months post mTBI.Results: Post-concussive symptoms, fatigue and anxiety were not associated with community integration or life satisfaction. However, depressive symptoms were negatively associated with community integration and life satisfaction.Conclusions: Among all acute post-concussive symptoms following mTBI, depressive symptoms seem to have strongest relationship with community integration and life satisfaction. Acute psychological intervention targeting these symptoms is strongly recommended.

Cognitive-communication performance following mild traumatic brain injury: Influence of sex, age, education, site of lesion and bilingualism.

BACKGROUND: Although previous research studies have defined several prognostic factors that affect cognitive-communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive-communication impairment in complicated mild TBI (mTBI) specifically. AIMS: To determine which demographic and trauma-related factors are associated with cognitive-communication performance in the early recovery phase of acute care following a complicated mTBI. METHODS & PROCEDURES: Demographic and accident-related data as well as the scores on cognitive-communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism. OUTCOMES & RESULTS: Females performed better than males on letter-category naming, while those more advanced in age performed worse on most cognitive-communication measures. Patients with higher education achieved better confrontation and letter-category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming. CONCLUSIONS & IMPLICATIONS: Cognitive-communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury-related factors affect cognitive-communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper adds What is already known on the subject In early acute recovery studies including all severity of TBI, cognitive-communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury-related variables predict cognitive-communication performance after a complicated mTBI specifically. What this paper adds to existing knowledge We confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive-communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive-communication skills in this group of patients. What are the potential or actual clinical implications of this work? The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive-communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care.

Early parosmia signs and affective states predicts depression and anxiety symptoms six months after a mild Traumatic Brain Injury.

This longitudinal study aimed to evaluate qualitative (parosmia) and quantitative (hyposmia/anosmia) olfaction 2-4 weeks (baseline) and six months (follow-up) after a mild traumatic brain injury (mTBI). We further evaluated the predictive value of baseline depression, anxiety and olfaction scores on depression and anxiety at follow-up. At baseline, olfactory function and affective state were assessed in 107 participants (53 patients with mild TBI; 54 healthy controls). At follow-up, data were collected on 71 participants (32 patients, 39 controls). Both at baseline and follow-up, patients with mild TBI showed more signs of parosmia, depression and anxiety, compared to controls. However, patients did not, neither at baseline nor follow-up, show quantitative olfactory impairment. Moreover, while baseline scores of depression and anxiety helped predict the development of symptoms of depression and anxiety at follow up, adding parosmia scores to the prediction model significantly increased the amount of explained variances. Clinicians should implement affective and olfactory evaluation to predict patients' affective outcome.

Cognitive-communication skills and acute outcome following mild traumatic brain injury.

PURPOSE: Little is known about cognitive-communication skills post mild traumatic brain injury (mTBI). We aimed to determine how performance on cognitive-communication measures in the acute recovery period relates to early outcome following complicated mTBI. METHOD: Results of language and communication skill measures, demographic and accident-related data, length of stay (LOS), Glasgow Outcome Scale-Extended (GOSE) scores and discharge destinations were retrospectively gathered for 128 admitted patients with complicated mTBI. RESULTS: More than half of the individuals required rehabilitation services post discharge from hospital with over a third needing in-patient rehabilitation. Patients with poorer skills in auditory comprehension, verbal reasoning, confrontation naming, verbal fluency and conversational discourse were more likely to require in-patient rehabilitation. Subjects with worse skills in naming, conversational discourse and letter-category verbal fluency had a greater chance of being referred to out-patient rehabilitation services. Thus patients with both auditory comprehension and oral expression deficits were more likely to require in-patient services whereas those who had oral expression deficits but no significant difficulty in auditory comprehension were more often referred to out-patient services. Also, worse conversational discourse skills and semantic-category naming ability were related to lower GOSE scores and the chance of a longer LOS was greater when letter-category naming was poorer. CONCLUSION: The likelihood of individuals requiring rehabilitation services post mTBI was related to performance on several oral expression and auditory comprehension measures. It is therefore important to evaluate cognitive-communication skills early to determine rehabilitation needs.

Olfactory, cognitive and affective dysfunction assessed 24 hours and one year after a mild Traumatic Brain Injury (mTBI).

Objective: This cross-sectional study aimed to evaluate olfaction 24 h (baseline) and 1 year (follow-up) after a mild traumatic brain injury (TBI). We further evaluated the influence of the cognition and affective state on olfactory function. Method: At baseline, olfactory function, neuropsychological, and affective states were assessed in 42 patients (20 mild TBI; 22 orthopedic injury). At follow-up, 12 patients with mild TBI and 7 controls could be included, and we assessed olfactory function, affective states, and post-concussion symptoms. Results: At baseline, patients with mild TBI demonstrated significantly reduced olfactory function, compared to controls, with more than 55% of the patients presenting signs of hyposmia. One year later, no significant differences in olfactory scores between cases and controls were observed. However, patients with mild TBI who had exhibited hyposmia at baseline exhibited significantly higher anxiety levels and more post-concussion symptoms than patients with mild TBI with normal olfactory function at baseline. Conclusions: In the acute phase of mild TBI a majority of patients has impaired olfactory function. Further patients with olfactory dysfunction are more likely to exhibit post-concussion and anxious symptoms at follow-up. Olfactory testing in the acute phase may therefore serve as a screening tool for long-term outcome.

Prognostic value of neuron-specific enolase (NSE) for prediction of post-concussion symptoms following a mild traumatic brain injury: a systematic review.

BACKGROUND: This systematic review aimed to determine the prognostic value of neuron-specific enolase (NSE) to predict post-concussion symptoms following mild traumatic brain injury (TBI). METHODS: Seven databases were searched for studies evaluating the association between NSE levels and post-concussion symptoms assessed ≥ 3 months (persistent) or ≥ 7 days < 3 months (early) after mild TBI. Two researchers independently screened studies for inclusion, extracted data and appraised quality using the Quality in Prognostic Studies (QUIPS) tool. RESULTS: The search strategy yielded a total of 23,298 citations from which 8 cohorts presented in 10 studies were included. Studies included between 45 and 141 patients (total 608 patients). The outcomes most frequently assessed were post-concussion syndrome (PCS, 12 assessments) and neuropsychological performance deficits (10 assessments). No association was found between an elevated NSE serum level and PCS. Only one study reported a statistically significant association between a higher NSE serum level and alteration of at least three cognitive domains at 2 weeks but this association was no longer significant at 6 weeks. Overall, risk of bias of the included studies was considered moderate. CONCLUSIONS: Early NSE serum level is not a strong independent predictor of post-concussion symptoms following mild TBI.

Discharge Against Medical Advice in Traumatic Brain Injury: Follow-Up and Readmission Rate.

BACKGROUND: Patients who leave hospital against medical advice (AMA) may be at risk of adverse health outcomes, medical complications, and readmission. In this study, we examined the characteristics of patients who left AMA after traumatic brain injury (TBI), their rates of follow-up visits, and readmission. METHODS: We retrospectively studied 106 consecutive patients who left the tertiary trauma center AMA (1.8% of all admitted patients with a TBI). Preinjury health and social issues, mechanism of injury, computed tomography findings, and injury markers were collected. They were correlated to compliance with follow-up visits and unplanned emergency room (ER) visits and readmission rates. RESULTS: The most prevalent premorbid health or social-related issues were alcohol abuse (33%) and assault as a mechanism of trauma (33%). Only 15 (14.2%) subjects came to follow-up visit for their TBI. Sixteen (15.1%) of the 106 subjects had multiple readmissions and/or ER visits related to substance abuse. Seven (6.6%) had multiple readmissions or ER visits with psychiatric reasons. Those patients with multiple readmissions and ER visits showed in higher proportion preexisting neurological condition (p=0.027), homelessness (p=0.012), previous neurosurgery (p=0.014), preexisting encephalomalacia (p=0.011), and had a higher ISS score (p=0.014) than those who were not readmitted multiple times. CONCLUSIONS: The significantly increased risks of multiple follow-up visits and readmission among TBI patients who leave hospital AMA are related to a premorbid vulnerability and psychosocial issues. Clinicians should target AMA TBI patients with premorbid vulnerability for discharge transition interventions.

Comparative Outcomes of Traumatic Brain Injury from Biking Accidents With or Without Helmet Use.

OBJECTIVE: To determine if health outcomes and demographics differ according to helmet status between persons with cycling-related traumatic brain injuries (TBI). METHODS: This is a retrospective study of 128 patients admitted to the Montreal General Hospital following a TBI that occurred while cycling from 2007-2011. Information was collected from the Quebec trauma registry and the coroner's office in cases of death from cycling accidents. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated were length of stay (LOS), extended Glasgow outcome scale (GOS-E), injury severity scale (ISS), discharge destination and death. RESULTS: 25% of cyclists wore a helmet. The helmet group was older, more likely to be university educated, married and retired. Unemployment, longer intensive care unit (ICU) stay, severe intracranial bleeding and neurosurgical interventions were more common in the no helmet group. There was no significant association between the severity of the TBI, ISS scores, GOS-E or death and helmet wearing. The median age of the subjects who died was higher than those who survived. CONCLUSION: Cyclists without helmets were younger, less educated, single and unemployed. They had more severe TBIs on imaging, longer LOS in ICU and more neurosurgical interventions. Elderly cyclists admitted to the hospital appear to be at higher risk of dying in the event of a TBI.

Societal cost of traumatic brain injury: A comparison of cost-of-injuries related to biking with and without helmet use.

OBJECTIVE: The goal of this study is to determine if a difference in societal costs exists from traumatic brain injuries (TBI) in patients who wear helmets compared to non-wearers. METHODS: This is a retrospective cost-of-injury study of 128 patients admitted to the Montreal General Hospital (MGH) following a TBI that occurred while cycling between 2007-2011. Information was collected from Quebec Trauma Registry. The independent variables collected were socio-demographic, helmet status, clinical and neurological patient information. The dependent variables evaluated societal costs. RESULTS: The median costs of hospitalization were significantly higher (p = 0.037) in the no helmet group ($7246.67 vs. $4328.17). No differences in costs were found for inpatient rehabilitation (p = 0.525), outpatient rehabilitation (p = 0.192), loss of productivity (p = 0.108) or death (p = 1.000). Overall, the differences in total societal costs between the helmet and no helmet group were not significantly different (p = 0.065). However, the median total costs for patients with isolated TBI in the non-helmet group ($22, 232.82) was significantly higher (p = 0.045) compared to the helmet group ($13, 920.15). CONCLUSION: Cyclists sustaining TBIs who did not wear helmets in this study were found to cost society nearly double that of helmeted cyclists.

Traumatic brain injury in the elderly: A level 1 trauma centre study.

OBJECTIVE: To explore the characteristics and outcome of patients with TBI over 65 years old admitted to an acute care Level 1 Trauma centre in Montreal, Canada. METHODS: Data were retrospectively collected on patients (n = 1812) who were admitted post-TBI to the McGill University Health Centre-Montreal General Hospital from 2000-2011. The cohort was composed of four groups over 65 years old (65-75; 76-85; 86-95; and 96 and more). Outcome measures used were the extended Glasgow Outcome Scale (GOSE) as well as discharge destination. RESULTS: As the patients got older, the odds of having a poor outcome increased (OR = 2.344 for those 75-85 years old, 4.313 for those 86-95 years of age and 3.465 for those aged 96 years of age or older). Also, the proportion of patients going home or going home with out-patient rehabilitation decreased as age increased (p = 0.001 and p < 0.001, respectively). In contrast, the proportion of patients being discharged to long-term care facilities increased significantly as age increased (p < 0.001). CONCLUSION: This descriptive study provides a better understanding of characteristics and outcome of different age groups of patients with TBI all over 65 years old in Montreal, Canada.

Trends in Hospitalization Associated with TBI in an Urban Level 1 Trauma Centre.

OBJECTIVE: Traumatic brain injury (TBI) is the single largest cause of death and disability following injury worldwide. The aim of this study was to determine the demographic, clinical, medical and accident related trends for patients with TBI hospitalized in an urban level 1 Trauma Centre. METHODS: Data were retrospectively collected on individuals (n = 5,642) who were admitted to the Traumatic Brain Injury Program of the McGill University Health Centre - Montreal General Hospital from 2000 to 2011. RESULTS: Regression analysis showed a significant upward trend in the yearly number of cases as well as an upward trending by year in the proportion of TBI cases aged 70-years-old or more. The Injury Severity Scale scores were positively associated with year indicating a slight increase in injury severity over the years and there was an increase in patient psychological, social and medical premorbid complexity. In addition, the Extended Glasgow Outcome Scale score tended to become more severe over the years. There was a slight decrease in the proportion of discharges home and in the proportion of deaths. CONCLUSIONS: These results will help to understand the impact of TBI in an urban Canadian level 1 Trauma Centre. This information should be used to develop public prevention strategies and to educate the community about the risk of TBI especially the risk of falls in the ageing population. These findings can also provide information to help health policy makers plan for future resources.

Characteristics of patients with acute traumatic brain injury discharged against medical advice in a level 1 urban trauma centre.

PRIMARY OBJECTIVE: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA). RESEARCH DESIGN: Data were retrospectively collected on individuals (n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH. METHODS AND PROCEDURES: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®). MAIN OUTCOMES: The overall rate of patients leaving AMA was 1.9% (n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA (p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM: p = 0.032). CONCLUSIONS: Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital.

Early conversational discourse abilities following traumatic brain injury: an acute predictive study.

PRIMARY OBJECTIVE: To date, little information is available regarding communication and conversational discourse proficiency post-traumatic brain injury (TBI) in the acute care phase. The main goal of this study was to examine how conversational discourse impairment following TBI predicts early outcome. Factors which influence conversational discourse performance were also explored. METHODS: The conversational discourse checklist of the Protocole Montréal d'évaluation de la communication (D-MEC) was administered in an acute tertiary care trauma centre to 195 adults within 3 weeks post-TBI. Outcome was measured with the Disability Rating Scale (DRS), the extended Glasgow Outcome Scale (GOS-E) and included discharge destinations from acute care. MAIN OUTCOMES AND RESULTS: Linear regression results showed that the D-MEC total score, age and initial GCS score accounted for 50% of the variation of the DRS scores. The DRS score was lower, signifying better outcome, when the total D-MEC score was higher, the subject was younger and when the initial GCS score was higher. Moreover, D-MEC performance significantly predicted the moderate and severe disability categories of the GOS-E and the probability of requiring rehabilitation (p < 0.05). CONCLUSION: These results provide additional information to guide healthcare professionals in predicting overall outcome acutely post-TBI.