THE IMPACT OF ACUTE COMPLICATIONS, FRACTURES, AND MOTOR DEFICITS ON FUNCTIONAL OUTCOME AND LENGTH OF STAY AFTER TRAUMATIC BRAIN INJURY - A MULTICENTER ANALYSIS

Objective: To determine the influence of acute respiratory complicatio ns, gastrointestinal procedures, fractures, and motor deficits on leng th of stay (LOS) and functional outcome following traumatic brain inju ry (TBI). Design: Prospective multicenter analysis of consecutive admi ssions to designated TBI Model Systems of Care. Setting: Four National institute for Disability and Rehabilitation Research (NIDRR) TBI Mode l Systems centers for coordinated acute and rehabilitation care. Parti cipants: 637 adults with TBI were enrolled in the study from February 1989 through June 1995. One-year follow cv-up data were available on 2 70 subjects. Main Outcome Measures: Acute and rehabilitation LOS, Disa bility Rating Scale (DRS) score, and Functional Independence Measure ( FIM)) score. Results: Gastrostomies or jejunostomies were placed in 44 % of individuals and were associated with swallowing and feeding probl ems at rehabilitation admission and discharge. Respiratory complicatio ns occurred in 39% of individuals and were associated with increased a cute and rehabilitation LOS (P <.0005). Pelvic and lower extremity fra ctures occurred in 21% of individuals, and upper extremity fractures o ccurred in 11%; both were associated with increased acute and rehabili tation LOS. Only lower extremity fractures were associated with the ne ed for physical assistance with functional activities at rehabilitatio n admission and discharge. Less-than-antigravity strength and moderate to severe incoordination were associated with the need for physical a ssistance with mobility and self-care at admission, at discharge, and at 1-year follow-up. AU of these associations diminished over time. Co nclusions: Medical complications associated with TBI and resultant mot or impairment negatively affect functioning at time of rehabilitation admission and discharge. These effects diminish by 1 year post injury.