Inconsistencies with screening for traumatic brain injury in spinal cord injury across the continuum of care

Seema Sikka, Angela Vrooman, Librada Callender, David Salisbury, Monica Bennett, Rita Hamilton, Simon Driver

Research output: Contribution to journalArticle

Abstract

Objective: Explore how traumatic brain injury (TBI) is screened among spinal cord injury (SCI) patients across the continuum of care. Design: Retrospective chart review Setting: Emergency department, trauma, inpatient rehabilitation Participants: 325 patients with SCI from inpatient rehabilitation facility (IRF) between March 1, 2011 and December 31, 2014 were screened. 49 eligible subjects had traumatic SCI and received care in adjoining acute care (AC) hospital. Outcome Measures: Demographic characteristics and variables that capture diagnosis of TBI/SCI included documentation from ambulance, emergency department, AC, and IRF including ICD-9 codes, altered mental status, loss of consciousness (LOC), Glasgow Coma Score, Post Traumatic Amnesia (PTA), neuroimaging, and cognitive assessments. Results: Participants were male (81%), white (55%), privately insured (49%), and aged 39.3±18.0 years with 51% paraplegic and 49% tetraplegic. Mechanisms of injury were gunshot wound (31%), fall (29%), and motor vehicle accident (20%). TBI occurred in 65% of SCI individuals, however documentation of identification of TBI, LOC, and CT imaging results varied in H&P, discharge notes, and ICD-9 codes across the continuum. Cognitive assessments were performed on 16% of subjects. Conclusions: Documentation showed variability between AC and IRF and among disciplines. Imaging and GCS were more consistently documented than LOC and PTA. It is necessary to standardize screening processes between AC and IRF to identify dual diagnosis.

Original languageEnglish (US)
Pages (from-to)51-56
Number of pages6
JournalJournal of Spinal Cord Medicine
Volume42
Issue number1
DOIs
StatePublished - Jan 2 2019
Externally publishedYes

Keywords

  • Brain injury
  • Rehabilitation
  • Spinal cord injury
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology

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