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 complications, gastrointestinal procedures, fractures, and motor deficits on length of stay (LOS) and functional outcome following traumatic brain injury (TBI). Design: Prospective multicenter analysis of consecutive admissions to designated TBI Model Systems of Care. Setting: Four National institute for Disability and Rehabilitation Research (NIDRR) TBI Model Systems centers for coordinated acute and rehabilitation care. Participants: 637 adults with TBI were enrolled in the study from February 1989 through June 1995. One-year follow cv-up data were available on 270 subjects. Main Outcome Measures: Acute and rehabilitation LOS, Disability 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 problems at rehabilitation admission and discharge. Respiratory complications occurred in 39% of individuals and were associated with increased acute and rehabilitation LOS (P <.0005). Pelvic and lower extremity fractures occurred in 21% of individuals, and upper extremity fractures occurred in 11%; both were associated with increased acute and rehabilitation LOS. Only lower extremity fractures were associated with the need for physical assistance with functional activities at rehabilitation admission and discharge. Less-than-antigravity strength and moderate to severe incoordination were associated with the need for physical assistance with mobility and self-care at admission, at discharge, and at 1-year follow-up. AU of these associations diminished over time. Conclusions: Medical complications associated with TBI and resultant motor impairment negatively affect functioning at time of rehabilitation admission and discharge. These effects diminish by 1 year post injury.