Medical Comorbidities in Disorders of Consciousness Patients and Their Association With Functional Outcomes

作者：Ganesh Shanti; Guernon Ann; Chalcraft Laura; Harton Brett; Smith Bridget; Pape Theresa Louise Bender^*

来源：Archives of Physical Medicine and Rehabilitation, 2013, 94(10): 1899-1907.

DOI：10.1016/j.apmr.2012.12.026

• Brain injuries
• Comorbidity
• Consciousness disorders
• Rehabilitation

Objective: To identify, for patients in states of seriously impaired consciousness, comorbid conditions present during inpatient rehabilitation and their association with function at 1 year. %26lt;br%26gt;Design: Abstracted data from a prospective cross-sectional observational study with data collection occurring January 1996 through December 2007. %26lt;br%26gt;Setting: Four inpatient rehabilitation facilities in metropolitan areas. %26lt;br%26gt;Participants: The study sample of 68 participants is abstracted from a database of 157 patients remaining in states of seriously impaired consciousness for at least 28 days. %26lt;br%26gt;Interventions: Not applicable. %26lt;br%26gt;Main Outcome Measure: One-year cognitive, motor, and total FIM score. %26lt;br%26gt;Results: The most common medical complications during inpatient rehabilitation for the study sample are active seizures (46%), spasticity (57%), urinary tract infections (47%), and hydrocephalus with and without shunt (38%). Presence of %26gt;= 3 medical complications during inpatient rehabilitation, controlling for injury severity, is significantly (P%26lt;.05) associated with poorer total FIM and FIM motor scores 1 year after injury. The presence of hydrocephalus with and without shunt (r=-.20, -.21, -.18; P %26lt;=.15), active seizures (r=-.31, -.22, -.42), spasticity (r=-.38, -.28, -.40), and urinary tract infections (r=-.25, -.24, -.26) were significantly (P%26lt;.10) associated with total FIM, FIM cognitive, and FIM motor scores, respectively. %26lt;br%26gt;Conclusions: Reported findings indicate that persons in states of seriously impaired consciousness with higher numbers of medical complications during inpatient rehabilitation are more likely to have lower functional levels 1-year postinjury. The findings indicate that persons with %26gt;= 3 medical complications during inpatient rehabilitation are at a higher risk for poorer functional outcomes at 1 year. It is, therefore, prudent to evaluate these patients for indications of these complications during inpatient rehabilitation.

• 出版日期2013-10
• 单位西北大学