Model System:

TBI

Reference Type:

Journal article

Accession No.:

J84177

Journal:

Rehabilitation Psychology

Year, Volume, Issue, Page(s):

, 63, 4, 588-594

Publication Website:

Abstract:

Study compared recovery experienced during inpatient rehabilitation among individuals with traumatic brain injury (TBI) based on whether their acute care included the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol. The management protocol involves monitoring symptoms through serial administration of the CIWA scale and administration of medications. Participants included 234 individuals with TBI who completed inpatient rehabilitation at a TBI Model Systems site. Of these, 67 patients were treated using the CIWA protocol (TBI+CIWA); 167 patients were treated for TBI alone (TBI only). Demographic, injury, and treatment variables were compared between the 2 groups. A repeated-measures analysis of variance (ANOVA) compared Disability Rating Scale (DRS) scores between the groups at admission and discharge from inpatient rehabilitation. There was no significant difference between the two groups based on mean DRS scores at admission (TBI+CIWA = 9.6 versus TBI only = 10.1). There was a significant difference in mean DRS scores at discharge, with the TBI+CIWA group having lower scores (6.4 versus 7.0). A repeated-measures ANOVA of DRS scores from admission to discharge revealed a significant between-subjects effect based on patients' Mississippi categorization of posttraumatic amnesia (PTA) duration and age but not based on their CIWA status. A post hoc comparison including age as a covariate revealed a significant difference based on CIWA status within the "moderate" injury group at discharge, with the TBI+CIWA group having lower discharge DRS scores. Given the significant symptom overlap between alcohol withdrawal and PTA, it is likely that these 2 delirium presentations are confounded during the initial recovery from TBI, leading to "overestimation" of injury severity-particularly among individuals with moderate TBI.

Author(s):

Klyce, Daniel W. |Graham, Kristin M. |Lacey, Russell W. |Carter, William E.|

Participating Centers: