Journal:Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):16, 97, 10, 1628-1634
Study evaluated the diagnostic accuracy of a self-report measure of traumatic brain injury (TBI) in people with spinal cord injury (SCI), and assessed the potential effect of TBI on acute and postacute inpatient rehabilitation outcomes. Step 2 of the Traumatic Brain Injury-4 (TBI-4) interview was used to estimate the presence and severity of TBI in 105 participants admitted to 2 SCI Model Systems programs. The TBI-4 was developed to identify people with a lifetime history of TBI among veterans seeking mental health services; Step 2 was found to be the best indicator of “probable TBI.” The incidence of TBI as determined by the TBI-4 self-report was compared with diagnosis based on a systematic medical records review by physicians blinded to self-reported TBI. Estimated incidence of TBI was 33 percent by chart review and 60 percent based on Step 2 of the TBI-4. Ninety-one percent of those with TBI based on chart review sustained mild injuries. At the optimal cutoff of “possible TBI,” the TBI-4 had a sensitivity of 83 percent, a specificity of 51 percent, and a Youden Index of 0.3. Compared with those without TBI, those with chart review-determined TBI had nonsignificant trends toward a longer acute care length of stay and a higher functional status at rehabilitation discharge, but equivalent 1-year outcomes. Step 2 of theTBI-4 did not meet Youden’s criteria (≥0.8) for good diagnostic accuracy in the context of recent SCI. Comorbid TBIs were almost exclusively mild and not associated with poorer outcomes 1 year after SCI.