The Impact of a Comorbid Spinal Cord Injury on Cognitive Outcomes of Male and Female Patients with Traumatic Brain Injury

Screening and outcomes of co-occurring traumatic brain injury among people with spinal cord injury: a scoping review

OBJECTIVE

To map existing knowledge on screening and rehabilitation outcomes for co-occurring traumatic brain injury among people with traumatic spinal cord injury (SCI).

METHODS

Articles focusing on screening and rehabilitation outcomes in participants sustaining co-occurring traumatic brain injury and traumatic spinal cord injury (all ages) were identified in Ovid, Scopus, Web of Science, CINAHL, and ProQuest Dissertations and Theses electronic databases. There were no limitations on study design, date, or geographical location. Articles were excluded if they were not available in English. Data were extracted into the Rayyan online collaboration platform and summarized descriptively.

RESULTS

Twenty-five studies were included, with a mix of retrospective, case-control, and prospective cohort designs. Screening under-estimated traumatic brain injury incidence when approaches relied on inconsistently collected traumatic brain injury indicators, especially for mild traumatic brain injury. Rehabilitation outcomes included length of stay, functional outcomes, cognitive functioning, complication rates, and employment. Although mixed, outcomes among persons with moderate to severe co-occurring traumatic brain injury especially, appeared poorer than those with spinal cord injury alone.

CONCLUSIONS

Multivariable approaches to traumatic brain injury ascertainment and greater consistency in documenting acute traumatic brain injury indicators may improve reliability of capturing traumatic brain injury and traumatic brain injury severity among persons with traumatic spinal cord injury. Impacts of co-occurring traumatic brain injury appear greater relative to SCI alone but few studies analysed outcomes based on traumatic brain injury severity.

A Comprehensive Review of the Importance of the Main Comorbidities in Developing Cognitive Disorders in Patients With Spinal Cord Injuries

Spinal cord injuries (SCI) refer to lesions in the spinal cord due to direct trauma (traumatic SCI-TSCI), such as vehicle accidents, falls, and violent events, or other pathological conditions (non-traumatic SCI) such as metabolic disorders, inflammation, or degenerative disorders. Depending on the location of the injury, patients may experience movement and/or sense disabilities in their lower limbs, torso, or upper limbs. Even though poorly studied, it has been found that such patients have a higher risk of developing cognitive disorders, such as deficits in concentration, short and long memory, comprehension, and problem-solving, as well as mental deficits in the form of difficulty socializing and expressing emotions. The main contributing factor of cognitive impairment in patients with SCI has been identified as a traumatic brain injury (TBI), but other comorbidities play an important role. In spite of the correlation that has been found between certain comorbidities and cognitive impairment in patients with SCI, further investigation into the importance of these pathological states as well as future research into the approach of these patients is necessary.

Evaluation of clinical outcomes and employment status in veterans with dual diagnosis of traumatic brain injury and spinal cord injury

PURPOSE

To examine clinical outcomes and employment status in Veterans with and without a dual diagnosis of traumatic brain injury (TBI) and spinal cord injury (SCI).

METHODS

This cross-sectional study examined a national sample of Veterans enrolled in the VA Million Veteran Program who completed the Comprehensive TBI Evaluation (CTBIE) as part of the Veterans Health Administration's TBI Screening and Evaluation Program. Veterans (N = 12,985) were classified into the following TBI/SCI groups using CTBIE data: those with a dual diagnosis of TBI and SCI (TBI+/SCI+); those with a history of TBI but no SCI (TBI+/SCI-); and those with no history of TBI or SCI (TBI-/SCI-; i.e., the control group). CTBIE-derived outcomes included neurobehavioral symptoms, comorbid psychiatric symptoms, pain and pain interference, and employment status.

RESULTS

Chi-square analyses showed significant associations between TBI/SCI group and all clinical outcomes evaluated (all p's < .001; V = 0.07-0.11). In general, the TBI+/SCI+ and TBI +/SCI- groups endorsed comparable levels of neurobehavioral symptoms, psychiatric symptoms, and pain, but significantly greater rates of symptoms and pain relative to the TBI-/SCI- group. Effect sizes for all pairwise comparisons were small (φ = 0.01-0.11). Finally, there was no significant association between TBI/SCI group and employment status (p = .170; V = 0.02), with all three groups showing relatively comparable rates of unemployment.

CONCLUSIONS

Regardless of SCI status, Veterans with TBI history endorsed poorer clinical outcomes than Veterans without TBI and SCI. However, rates of unemployment were similarly high across all three groups. Findings suggest that any Veteran completing the CTBIE may be at risk for poor clinical and employment outcomes.

Dual diagnosis of TBI and SCI: an epidemiological study in the pediatric population

Introduction

Dual diagnosis (DD) with traumatic brain injury (TBI) and spinal cord injury (SCI) poses clinical and rehabilitation challenges. While comorbid TBI is common among adults with SCI, little is known about the epidemiology in the pediatric population. The primary objective of this study was to evaluate the prevalence of TBI among children in the United States hospitalized with SCI. Secondary objectives were to compare children hospitalized with DD with those with isolated SCI with regards to age, gender, race, hospital length of stay, and hospital charges.

Methods

A retrospective analysis of hospital discharges among children aged 0-18 years occurring between 2016-2018 from U.S. hospitals participating in the Kids' Inpatient Database. ICD-10 codes were used to identify cases of SCI, which were then categorized by the presence or absence of comorbid TBI.

Results

38.8% of children hospitalized with SCI had a co-occurring TBI. While DD disproportionately occurred among male children (67% of cases), when compared with children with isolated SCI, those with DD were not significantly more likely to be male. They were more likely to be Caucasian. The mean age of children with DD (13.2 ± 5.6 years) was significantly less than that of children with isolated SCI (14.4 ± 4.3 years). DD was associated with longer average lengths of stay (6 versus 4 days) and increased mean total hospital charges ($124,198 versus $98,089) when compared to isolated SCI.

Conclusion

Comorbid TBI is prevalent among U.S. children hospitalized with SCI. Future research is needed to better delineate the impact of DD on mortality, quality of life, and functional outcomes.

Neurologic Outcome Prediction in the Intensive Care Unit

PURPOSE OF REVIEW

The burden of severe and disabling neurologic injury on survivors, families, and society can be profound. Neurologic outcome prediction, or neuroprognostication, is a complex undertaking with many important ramifications. It allows patients with good prognoses to be supported aggressively, survive, and recover; conversely, it avoids inappropriate prolonged and costly care in those with devastating injuries.

RECENT FINDINGS

Striving to maintain a high prediction performance during prognostic assessments encompasses acknowledging the shortcomings of this task and the challenges created by advances in medicine, which constantly shift the natural history of neurologic conditions. Embracing the unknowns of outcome prediction and the boundaries of knowledge surrounding neurologic recovery and plasticity is a necessary step toward refining neuroprognostication practices and improving the accuracy of prognostic impressions. The pillars of modern neuroprognostication include comprehensive characterization of neurologic injury burden (primary and secondary injuries), gauging cerebral resilience and estimated neurologic reserve, and tying it all together with individual values surrounding the acceptable extent of disability and the difficulties of an arduous convalescence journey.

SUMMARY

Comprehensive multimodal frameworks of neuroprognostication using different prognostic tools to portray the burden of neurologic injury coupled with the characterization of individual values and the degree of cerebral reserve and resilience are the cornerstone of modern outcome prediction.