Raj G Kumar1, Jennifer Olsen, Shannon B Juengst, Kristen Dams-OʼConnor, Therese M OʼNeil-Pirozzi, Flora M Hammond, Amy K Wagner. 1. Departments of Physical Medicine & Rehabilitation (Drs Kumar, Olsen, and Wagner) and Epidemiology (Dr Kumar), Clinical and Translational Science Institute, Center for Neuroscience, and Safar Center for Resuscitation Research (Dr Wagner), University of Pittsburgh, Pennsylvania; Departments of Physical Medicine and Rehabilitation (Dr Juengst) and Rehabilitation Counseling (Dr Juengst), UT Southwestern, Dallas, Texas; Department of Rehabilitation and Human Performance and Department of Neurology, Icahn School of Medicine at Mount Sinai, New York (Dr Dams-O'Connor); Department of Communication Sciences and Disorders, Northeastern University, Boston, Massachusetts (Dr O'Neil-Pirozzi); Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts (Dr O'Neil-Pirozzi); and Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (Dr Hammond).
Abstract
OBJECTIVES: To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI). DESIGN: Prospective cohort study. PARTICIPANTS: Adults 50 years and older with moderate-to-severe TBI (n = 2134). MEASURES: Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale-Extended (GOS-E) at 1 year). RESULTS: Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization. CONCLUSION: Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.
OBJECTIVES: To assess the relationship of acute complications, preexisting chronic diseases, and substance abuse with clinical and functional outcomes among adults 50 years and older with moderate-to-severe traumatic brain injury (TBI). DESIGN: Prospective cohort study. PARTICIPANTS: Adults 50 years and older with moderate-to-severe TBI (n = 2134). MEASURES: Clusters of comorbid health conditions empirically derived from non-injury International Classification of Diseases, Ninth Revision codes, demographic/injury variables, and outcome (acute and rehabilitation length of stay [LOS], Functional Independence Measure efficiency, posttraumatic amnesia [PTA] duration, institutionalization, rehospitalization, and Glasgow Outcome Scale-Extended (GOS-E) at 1 year). RESULTS: Individuals with greater acute hospital complication burden were more often middle-aged men, injured in motor vehicle accidents, and had longer LOS and PTA. These same individuals experienced higher rates of 1-year rehospitalization and greater odds of unfavorable GOS-E scores at 1 year. Those with greater chronic disease burden were more likely to be rehospitalized at 1 year. Individuals with more substance abuse burden were most often younger (eg, middle adulthood), black race, less educated, injured via motor vehicle accidents, and had an increased risk for institutionalization. CONCLUSION: Preexisting health conditions and acute complications contribute to TBI outcomes. This work provides a foundation to explore effects of comorbidity prevention and management on TBI recovery in older adults.
Authors: Raj G Kumar; Jessica M Ketchum; Flora M Hammond; Thomas A Novack; Therese M O'Neil-Pirozzi; Marc A Silva; Kristen Dams-O'Connor Journal: Brain Inj Date: 2022-02-10 Impact factor: 2.167
Authors: Flora M Hammond; John D Corrigan; Jessica M Ketchum; James F Malec; Kristen Dams-OʼConnor; Tessa Hart; Thomas A Novack; Jennifer Bogner; Marie N Dahdah; Gale G Whiteneck Journal: J Head Trauma Rehabil Date: 2019 Jul/Aug Impact factor: 2.710
Authors: Emily Evans; Cicely Krebill; Roee Gutman; Linda Resnik; Mark R Zonfrillo; Stephanie N Lueckel; Wenhan Zhang; Raj G Kumar; Kristen Dams-O'Connor; Kali S Thomas Journal: PM R Date: 2021-06-28 Impact factor: 2.218
Authors: Emily Evans; Roee Gutman; Linda Resnik; Mark R Zonfrillo; Stephanie N Lueckel; Raj G Kumar; Frank DeVone; Kristen Dams-O'Connor; Kali S Thomas Journal: J Head Trauma Rehabil Date: 2021 May-Jun 01 Impact factor: 3.117