Factors affecting functional outcomes of traumatic brain injury rehabilitation at a rehabilitation facility in Saudi Arabia

Case Report: Non-convulsive seizure following traumatic brain injury - a significant occurrence that needs to be considered due to potential long-term sequelae

Introduction/background

Non convulsive seizures (NCS) following traumatic brain injury (TBI) may remain undiagnosed due to lack of overt clinical manifestation and can have long-term sequelae due to delay in timely treatment. Occurrence of early NCS is known to have subsequent neurologic sequelae due to excitotoxic neuronal injury.

Case report

This is a case report of a young girl who sustained a TBI due to a motor vehicle accident (MVA) and was admitted with a fluctuating level of consciousness. Her clinical presentation was attributed to TBI; however as her conscious level did not recover, an electroencephalogram (EEG) was requested, which detected non convulsive status epilepticus (NCSE). Anti-seizure medication (ASM) was started. Her follow-up EEG and magnetic resonance imaging (MRI) were suggestive of the potential adverse effects of prolonged NCSE.

Conclusion

NCS may remain undiagnosed in TBI due to a paucity of overt clinical manifestations. Every patient with TBI and altered consciousness at presentation should be evaluated by continuous EEG monitoring immediately, if possible, in the emergency department to avoid long-term sequelae of NCS in such cases.

Delayed discharges at a tertiary rehabilitation centre in Saudi Arabia: contributing factors and cost impact

There are various challenges in discharging hospitalized patients with disabilities. Discharge process for individuals with disabilities is multifactorial and can vary from one health system to another. The current study is aimed to explore the factors contributing to delayed discharges and to determine the number of exceeded bed days and subsequent cost impact at a government rehabilitation facility in Saudi Arabia. This retrospective cohort study was conducted at the Rehabilitation Hospital of King Fahad Medical City, Riyadh. All the 2285 discharges from inpatient rehabilitation from August 2011 to March 2017 were included in the study. Patients with delayed discharge were identified. Information about the diagnosis and reasons for delayed discharge was obtained from the rehabilitation hospital bed utilization data. The cost impact was calculated based on the number of days patients stayed beyond the estimated length of stay for each diagnosis. Of the 2285 discharges, 531 (23.3%) were delayed. The most common clinical conditions of patients with delayed discharge included spinal cord injury (n = 168, 31.6%) and traumatic brain injury (n = 145, 27.3%). The factors that led to delayed discharges were medical complications (n = 352, 66.7%), organizational factors (n = 83, 15.7%), family factors (n = 46, 8.7%), and external factors (n = 46, 8.7%). A total of 21 817 hospital bed days were exceeded, with an approximate estimated cost of 80 million Saudi Arabian Riyals. Early rehabilitation and enhancement of the discharge process may significantly decrease delayed discharge rates. Strategies need to be adapted to identify patients at risk of delayed discharge based on the factors highlighted in this study. Development of long-term care capacity, community services, and optimizing family and social support can promote timely discharge.

Outcomes of Neurorehabilitation Among Patients With Prolonged Disorders of Consciousness

BACKGROUND

 The impact of neurorehabilitation on patients with prolonged disorders of consciousness (PDOC) is not well known. We assessed the range of motion (ROM), muscle girth and power, level of consciousness, development of musculoskeletal deformity, and superficial sensation.

METHODS

 A retrospective observational record-based study was done, which included the data of patients diagnosed with PDOC admitted at Thumbay Physical Therapy & Rehabilitation Hospital, Ajman, UAE, between 2020 and 2022. Data on the "range of motion", "muscle girth and power", "level of consciousness", "development of musculoskeletal deformity", and "superficial sensation" were collected and analyzed. The SPSS software version 27 (IBM Corp., Armonk, NY, USA) was used for analysis. The chi-square test was used to assess association, and the t-test was used to test the mean difference.

RESULTS

 We assessed the data of 21 patients with PDOC. The superficial sensation was found to have increased significantly (p<0.025). There was a decrease in the proportion of patients with musculoskeletal deformities during the follow-up period. The ROM, muscle girth, and muscle power were also preserved without significant deterioration. However, the level of consciousness measured by the Glasgow coma scale (GCS) showed no improvement.

CONCLUSIONS

Our research showed that neurorehabilitation significantly improves superficial sensation and prevents the development of musculoskeletal deformities. However, the mean level of consciousness remained the same. There was also no decrease in ROM. Both muscle girth and power were preserved over two years.

Traumatic Brain Injury Cases' Mortality Predictors, Association, and Outcomes in the Emergency Department at a Tertiary Healthcare Center in Saudi Arabia

Aim Incidence of traumatic brain injury (TBI) in Saudi Arabia has been estimated to be 116 per 1,00,000 population as incidence of TBI continues to rise in our region. We aim to study the demographics, mortality predictors, and factors influencing the outcome of TBI cases in a tertiary care center in Jeddah, Saudi Arabia.

Materials and Methods We retrospectively collected data from all consecutive patients treated at the Emergency Department of King Abdulaziz Medical City including all acute TBI adult cases (>18 years) from 2016 to 2019. Logistic regression models were used to identify significant predictors of mortality. A total of 423 individuals with TBI were enrolled in the study. Nearly, half of them were in age group of 18 to 29 (40.77). Most patients were males (76.83%).

Results Injuries were most commonly mild-to-moderate TBI (73.83%). Road traffic accident was the most common mechanism of injury (49.7%) followed by fall (39.5%). Most common mode of transportation was private cars (47.57%). Most patient required less than or equal to24hours of admission (61.23%). A total of 30 (7%) died in the hospital all of which were male with no death cases reported among females.

Conclusion In conclusion, this study reports a mortality rate related to TBI that is among the lowest in the region. Injuries were male predominant with more balanced male to female ratio. Patients who were delivered to the hospital via private cars had an improved survival. These finding should be interpreted in the context of retrospective noncontrolled study design, and further future studies are encouraged to consolidate these findings.

Employment and occupational safety among patients with seizure disorders - findings from a tertiary hospital in Saudi Arabia

OBJECTIVE

Observational studies suggest that persons with seizure disorders are socially disadvantaged compared to the general population. There are scarce reports in the literature on the prevalence of employment and occupational safety among patients with seizure disorders in Saudi Arabia. We aimed to describe the occupational statuses of patients with seizure disorders and determine factors associated with unemployment.

METHODS

This was a cross-sectional study conducted at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. Five-hundred-and-forty patients with known seizure disorders or epilepsy who attended neurology and neurosurgery outpatient clinics between January and November 2018 completed a semi-structured questionnaire delivered by interview.

RESULTS

Forty-four percent of participants were unemployed (27% of males and 64% of females). Fifteen percent of currently or previously employed participants reported that they had formerly resigned from their job due to their seizure disorder, most commonly as a result of their own fears or concerns. Almost half of the participants reported that their employer made arrangements in the workplace for their seizure disorder, while 18% reported that they did not disclose their diagnosis. Gender, age, and highest educational level were associated with employment status and reason for unemployment. Patients with seizures secondary to trauma were less than half as likely to be employed compared to other participants (aOR = 0.45 95%CI 0.21-0.97, p = 0.042). Holding a driving license increased the odds of being employed (aOR = 2.68 95%CI 1.32-5.46, p = 0.007). Participants on 4 or more antiepileptic medications were more likely to report not being well enough to work.

SIGNIFICANCE

Patients with seizure disorders are at increased risk of unemployment, even though many desire work. Unemployment is linked to social factors rather than disease-specific characteristics. Employers in Saudi Arabia generally accommodate patients in the workplace; however, individuals should further be empowered with information on safety in the workplace and their rights to employment.