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

Model System:

TBI

Reference Type:

Journal article

Accession No.:

J80345

Journal:

Journal of Spinal Cord Medicine - JSCM (formerly Journal of the American Paraplegia Society)

Year, Volume, Issue, Page(s):

2019 , 42, 1, 51-56

Publication Website:

Abstract:

Study explored how traumatic brain injury (TBI) is screened among patients with spinal cord injury (SCI) across the continuum of care. The medical records of 325 patients with SCI admitted to an inpatient rehabilitation facility (IRF) between March 1, 2011 and December 31, 2014 were retrospectively reviewed. Forty-nine eligible subjects had traumatic SCI and received care in adjoining acute care (AC) hospital. Analyzed data included 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. Participants were mostly male (81 percent), white (55 percent), and privately insured (49 percent), with a mean age of 39.3 years; 51 percent were paraplegic and 49 percent were tetraplegic. Mechanisms of injury were gunshot wound (31 percent), fall (29 percent), and motor vehicle accident (20 percent). TBI occurred in 65 percent 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 percent of subjects. 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.

Author(s):