ADMISSION EXAMINATION FACTORS PREDICTING COGNITIVE IMPROVEMENT DURINGACUTE BRAIN INJURY REHABILITATION

In this study 46 brain-injured patients admitted to a brain injury inp atient rehabilitation programme after acute care were evaluated at the bedside with a comprehensive mental status examination and physical e valuation. Using multiple regression analysis, elements of the cogniti ve and physical examinations were studied to determine if any of these items, individually or collectively, had predictive value for dischar ge functional status. A principal-components analysis identified meani ngful clusters of items. Factor I, Simple Cognitive Operations, consis ted of word repetition, naming and comprehension of simple commands. F actor IV, Higher Cognitive Operations, consisted of interpretation of similarities and reverse digit span. Other items, including elements o f the physical examination such as eye movements, hearing and ambulato ry function, were also clustered into factors. Stepwise multiple regre ssion analysis led to a conclusion that only factor IV was a significa nt predictor of Discharge Rancho Level, with the predictive power of f actor I and Admission Rancho Level subsumed by factor IV. This model, using a few items from a bedside mental status examination, accounted for 27% of the variance in Discharge Rancho Level in patients admitted to a brain injury rehabilitation unit after injury. We conclude that a brief mental status examination in a rehabilitation inpatient settin g can be useful in predicting outcome in patients with brain injuries. More research is needed to identify additional test items that will a dd prognostic power to the initial evaluation of patients with brain i njuries admitted to a rehabilitation unit.