Medical Complications During Inpatient Rehabilitation Among Patients With Traumatic Disorders of Consciousness

Whyte, John; Nordenbo, Annette; Kalmar, Kathleen; Merges, Barbara; Bagiella, Emilia; Chang, Helena L.; Yablon, Stuart A.; Cho, Sooja; Hammond, Flora M.; Khademi, Allen; Giacino, Joseph T.

doi:10.1016/j.apmr.2012.12.027

Cited by 101 publications

(80 citation statements)

References 14 publications

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“…Moreover, their prognostic value is enhanced if they are combined with the AFR score. Accurately determining prognoses for patients with severe disorders of consciousness is still a challenge for clinicians, and the comprehensive clinical status of a patient, including age, etiology, clinical presentation, and medical complications, should not be disregarded (Royal College of Physicians, 2003;Monti et al, 2010;Whyte et al, 2013). Neurophysiological and neuroimaging data should be integrated with clinical data to determine better prognoses for patients with UWS and MCS.…”

Section: Discussionmentioning

confidence: 98%

EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Bagnato

Boccagni

Sant’Angelo

et al. 2015

Clinical Neurophysiology

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Section: Discussionmentioning

confidence: 98%

EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Bagnato

Boccagni

Sant’Angelo

et al. 2015

Clinical Neurophysiology

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“…139 Whyte et al followed 181 rehabilitation inpatients in traumatic VS or MCS over a 6-week period, and found the median number of medical complications experienced per patient to be 2 (range 0-9). 140 The five most common complications were hypertonia/spasticity (8.3%), urinary tract infection (6.4%), agitation/aggression (6.4%), sleep disturbance (6.2%), and hyperkinesia/motor restlessness (4.7%). Pneumonia was relatively infrequent (3%) but was typically rated as severe, and was the most common reason for acute-care transfer.…”

Section: Prevention and Management Of Complicationsmentioning

confidence: 99%

Disorders of consciousness after acquired brain injury: the state of the science

et al. 2014

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| The concept of consciousness continues to defy definition and elude the grasp of philosophical and scientific efforts to formulate a testable construct that maps to human experience. Severe acquired brain injury results in the dissolution of consciousness, providing a natural model from which key insights about consciousness may be drawn. In the clinical setting, neurologists and neurorehabilitation specialists are called on to discern the level of consciousness in patients who are unable to communicate through word or gesture, and to project outcomes and recommend approaches to treatment. Standards of care are not available to guide clinical decision-making for this population, often leading to inconsistent, inaccurate and inappropriate care. In this Review, we describe the state of the science with regard to clinical management of patients with prolonged disorders of consciousness. We review consciousness-altering pathophysiological mechanisms, specific clinical syndromes, and novel diagnostic and prognostic applications of advanced neuroimaging and electrophysiological procedures. We conclude with a provocative discussion of bioethical and medicolegal issues that are unique to this population and have a profound impact on care, as well as raising questions of broad societal interest.

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“…Among individuals with disordered consciousness receiving acute inpatient rehabilitation for severe TBI, Whyte et al 21 found rehabilitation patients (who were deemed medically stable for a research trial) on average experienced a rate of 0.4 complications per week per patient with more than 80% experiencing at least 1 new medical complication during the 6 week observation period during inpatient rehabilitation. Newly documented medical complications included hypertonia, agitation/aggression, urinary tract infection, and sleep disturbance, and new complications that were considered severe included hydrocephalus, pneumonia, gastrointestinal problems, and paroxysmal sympathetic hyperactivity.…”

mentioning

confidence: 99%

Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury

Horn

Smout

Beaulieu

et al. 2015

Archives of Physical Medicine and Rehabilitation

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Objective To investigate frequency, reasons, and factors associated with readmission to acute care (RTAC) during inpatient rehabilitation for traumatic brain injury (TBI). Design Prospective observational cohort. Setting Inpatient rehabilitation. Participants 2,130 consecutive admissions for TBI rehabilitation. Interventions Not applicable. Main Outcome Measure(s) RTAC incidence, RTAC causes, rehabilitation length of stay (RLOS), and rehabilitation discharge location. Results 183 participants (9%) experienced RTAC for a total 210 episodes. 161 patients experienced 1 RTAC episode, 17 had 2, and 5 had 3. Mean days from rehabilitation admission to first RTAC was 22 days (SD 22). Mean duration in acute care during RTAC was 7 days (SD 8). 84 participants (46%) had >1 RTAC episode for medical reasons, 102 (56%) had >1 RTAC for surgical reasons, and RTAC reason was unknown for 6 (3%) participants. Most common surgical RTAC reasons were: neurosurgical (65%), pulmonary (9%), infection (5%), and orthopedic (5%); most common medical reasons were infection (26%), neurologic (23%), and cardiac (12%). Older age, history of coronary artery disease, history of congestive heart failure, acute care diagnosis of depression, craniotomy or craniectomy during acute care, and presence of dysphagia at rehabilitation admission predicted patients with RTAC. RTAC was less likely for patients with higher admission Functional Independence Measure Motor scores and education less than high school diploma. RTAC occurrence during rehabilitation was significantly associated with longer RLOS and smaller likelihood of discharge home. Conclusion(s) Approximately 9% of patients with TBI experience RTAC during inpatient rehabilitation for various medical and surgical reasons. This information may help inform interventions aimed at reducing interruptions in rehabilitation due to RTAC. RTACs were associated with longer RLOS and discharge to an institutional setting.

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Medical Complications During Inpatient Rehabilitation Among Patients With Traumatic Disorders of Consciousness

Cited by 101 publications

References 14 publications

EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

EEG predictors of outcome in patients with disorders of consciousness admitted for intensive rehabilitation

Disorders of consciousness after acquired brain injury: the state of the science

Readmission to an Acute Care Hospital During Inpatient Rehabilitation for Traumatic Brain Injury

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