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Poster 4: Hypermetabolism Following Moderate-to-Severe Traumatic Acute Brain Injury: A Systematic Review
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Early Career Poster Presentations Poster 1 The Predictors of Marital Stability 2 Years Following Traumatic Brain Injury. Juan Arango (Virginia Commonwealth University, Richmond, VA), Jessica Ketchum, Taryn Dezfulian. Disclosure: None declared. Objectives: To determine the predictors of continuous marital stability over 2 years and to examine the moderating effects of ethnicity. Design: Longitudinal follow-up. Setting: Traumatic Brain Injury Model System centers between 1989 and 2005. Participants: Nationwide sample of 977 diverse TBI survivors. Interventions: Not applicable. Main Outcome Measures: The variable marital stability was defined as “stably married” (married at admission and married at follow-up years 1 and 2) and “unstably married” (being single, divorced, or separated at any of the 2 follow-up years). Results: Across the 2 years postinjury, 85% of participants who reported being married at admission had stable marital status, while 15% indicated being separated or divorced. Younger age (odds ratio [OR]⫽4.03; 95% confidence interval [CI], 2.66 – 6.10), being male (OR⫽1.95; 95% CI, 1.11–3.35), suffering a TBI due to violence (OR⫽2.99; 95% CI, 1.56 –5.75), and having moderate injury severity (OR⫽2.27; 95% CI, 1.18 – 4.37) predicted marital instability. Furthermore, within minorities, increases in disability resulted in a higher likelihood of being stably married (P⫽.041). Conclusions: These research findings are clinically relevant and assist marital couples, family intervention therapists, and/or rehabilitation professionals to design programs early after injury to target these at-risk couples. Further research on the modifiable factors contributing to marital instability after TBI and potential moderators is needed. Key Words: Brain injuries; Marital stability; Minority groups; Rehabilitation. Poster 2 Influence of Minority Status on Job Stability After Traumatic Brain Injury. Juan Arango (Virginia Commonwealth University, Richmond, VA), Jessica Ketchum, Kelli Williams, Jeffrey Kreutzer, Therese O’Neil-Pirozzi, Paul Wehman, Carlos Marquez, Amitabh Jha. Disclosure: None declared. Objective: To determine the influence of minority status on job stability after traumatic brain injury (TBI). Design: Longitudinal follow-up. Setting: Traumatic Brain Injury Model System centers between 1988 and 2001. Participants: 633 persons with moderateto-severe TBI (414 white, 219 minorities). Interventions: Not applicable. Main Outcome Measures: Job stability defined as “stable” (competitively employed at all 3 follow-up visits), “unemployed” (not competitively employed at all 3 visits), and “unstable” (any other mixture of competitively employed and not competitively employed over the 3 follow-up visits). Results: Compared with whites, minorities were 3.587 times more likely to be unemployed versus being stably employed, 1.911 times more likely to be unstably employed versus being stably employed, and 1.878 times more likely to be unemployed versus being unstably employed after adjusting for preinjury employment status, age, marital status, education, cause of injury, total length of stay, and Disability Rating Scale at discharge. Conclusions: Minority status is an independent predictor of short-term job stability after TBI. Minority TBI survivors were more likely than whites to be unemployed or unstably employed. Rehabilitation professionals should develop employment interventions for the specific
needs of these racial and ethnic groups and facilitate optimal employment outcomes for minority TBI survivors. Key Words: Brain injuries; Minority groups; Rehabilitation. Poster 3 Detection of Delirium (Posttraumatic Acute Confusion) in Acquired Brain Injury. Jacob Kean (Indiana University, Bloomington, IN), Paula Trzepacz, Laura Murray, Lance Trexler, Malene A. Holder. Disclosure: None declared. Objective: To assess the accuracy and validity of a brief screening tool (Delirium Screening Scale [DSS]) for delirium (posttraumatic acute confusion) in patients with acquired brain injury. Design: Prospective correlational study. Setting: Acute inpatient brain injury rehabilitation unit. Participants: 36, ranging in age from 19 to 91 years, sampled from a group of consecutively admitted inpatients. Interventions: Not applicable. Main Outcome Measures: The DSM-IV diagnostic criteria for delirium and the Delirium Rating Scale–Revised–98 (DRS-R98). Results: The diagnostic accuracy of the DSS was referenced against independently rated DSM-IV diagnostic criteria using receiver operating characteristic curves. The DSS obtained an area under the curve of .994 (P⬍.001). Concurrent validity was assessed by correlating severity and duration of delirium measured by the DSS with that measured by the DRS-R98. Pearson product moment correlations for both severity (r⫽⫺.913, P⬍.001) and duration (r⫽.975, P⬍.001) were highly significant. Conclusions: The DSS appears to be an accurate and valid measure of delirium following acquired brain injury. Key Words: Brain injuries; Delirium; Rehabilitation. Poster 4 Hypermetabolism Following Moderate-to-Severe Traumatic Acute Brain Injury: A Systematic Review. Norine Foley (Lawson Health Research Institute, London, ON), Shawn Marshall, Jill Pikul, Katherine Salter, Robert Teasell. Disclosure: None declared. Objective: To describe the pattern of energy expenditure during the first 30 days following traumatic brain injury (TBI). Data Sources: Medline, Embase, CINAHL, ISI Web of Science, and the Cochrane Library (1966 to December 2007). Study Selection: Trials that measured energy expenditure at least once during the first 30 days postinjury were included. Data Extraction: Data including patient characteristics, medical management, and details of metabolic measurements were abstracted independently by 2 reviewers. Results are reported descriptively. Data Synthesis: 24 studies were identified. During the first 30 days, mean energy expenditure expressed as a percentage of predicted value ranged from 75% to 200%. The lowest values were reported in patients admitted in brain death. The administration of paralyzing agents, sedatives, or barbiturates reduced metabolic rate by approximately 12% to 32%. Propranolol and morphine were also associated with smaller decreases in energy expenditure (5%, 8%, respectively). Steroid usage and method of feeding (enteral vs parenteral) did not appear to further elevate metabolic rate. It was unclear if elevated temperature, the presence of extracranial injury, or the severity of injury contributed further to hypermetabolism. Conclusions: Energy expenditure was significantly elevated in most patients following TBI, although the magnitude of the effect was highly variable. Key Words: Brain injuries; Rehabilitation. Arch Phys Med Rehabil Vol 89, October 2008
Early Career Poster Presentations Poster 1 The Predictors of Marital Stability 2 Years Following Traumatic Brain Injury. Juan Arango (Virginia Commonwealth University, Richmond, VA), Jessica Ketchum, Taryn Dezfulian. Disclosure: None declared. Objectives: To determine the predictors of continuous marital stability over 2 years and to examine the moderating effects of ethnicity. Design: Longitudinal follow-up. Setting: Traumatic Brain Injury Model System centers between 1989 and 2005. Participants: Nationwide sample of 977 diverse TBI survivors. Interventions: Not applicable. Main Outcome Measures: The variable marital stability was defined as “stably married” (married at admission and married at follow-up years 1 and 2) and “unstably married” (being single, divorced, or separated at any of the 2 follow-up years). Results: Across the 2 years postinjury, 85% of participants who reported being married at admission had stable marital status, while 15% indicated being separated or divorced. Younger age (odds ratio [OR]⫽4.03; 95% confidence interval [CI], 2.66 – 6.10), being male (OR⫽1.95; 95% CI, 1.11–3.35), suffering a TBI due to violence (OR⫽2.99; 95% CI, 1.56 –5.75), and having moderate injury severity (OR⫽2.27; 95% CI, 1.18 – 4.37) predicted marital instability. Furthermore, within minorities, increases in disability resulted in a higher likelihood of being stably married (P⫽.041). Conclusions: These research findings are clinically relevant and assist marital couples, family intervention therapists, and/or rehabilitation professionals to design programs early after injury to target these at-risk couples. Further research on the modifiable factors contributing to marital instability after TBI and potential moderators is needed. Key Words: Brain injuries; Marital stability; Minority groups; Rehabilitation. Poster 2 Influence of Minority Status on Job Stability After Traumatic Brain Injury. Juan Arango (Virginia Commonwealth University, Richmond, VA), Jessica Ketchum, Kelli Williams, Jeffrey Kreutzer, Therese O’Neil-Pirozzi, Paul Wehman, Carlos Marquez, Amitabh Jha. Disclosure: None declared. Objective: To determine the influence of minority status on job stability after traumatic brain injury (TBI). Design: Longitudinal follow-up. Setting: Traumatic Brain Injury Model System centers between 1988 and 2001. Participants: 633 persons with moderateto-severe TBI (414 white, 219 minorities). Interventions: Not applicable. Main Outcome Measures: Job stability defined as “stable” (competitively employed at all 3 follow-up visits), “unemployed” (not competitively employed at all 3 visits), and “unstable” (any other mixture of competitively employed and not competitively employed over the 3 follow-up visits). Results: Compared with whites, minorities were 3.587 times more likely to be unemployed versus being stably employed, 1.911 times more likely to be unstably employed versus being stably employed, and 1.878 times more likely to be unemployed versus being unstably employed after adjusting for preinjury employment status, age, marital status, education, cause of injury, total length of stay, and Disability Rating Scale at discharge. Conclusions: Minority status is an independent predictor of short-term job stability after TBI. Minority TBI survivors were more likely than whites to be unemployed or unstably employed. Rehabilitation professionals should develop employment interventions for the specific
needs of these racial and ethnic groups and facilitate optimal employment outcomes for minority TBI survivors. Key Words: Brain injuries; Minority groups; Rehabilitation. Poster 3 Detection of Delirium (Posttraumatic Acute Confusion) in Acquired Brain Injury. Jacob Kean (Indiana University, Bloomington, IN), Paula Trzepacz, Laura Murray, Lance Trexler, Malene A. Holder. Disclosure: None declared. Objective: To assess the accuracy and validity of a brief screening tool (Delirium Screening Scale [DSS]) for delirium (posttraumatic acute confusion) in patients with acquired brain injury. Design: Prospective correlational study. Setting: Acute inpatient brain injury rehabilitation unit. Participants: 36, ranging in age from 19 to 91 years, sampled from a group of consecutively admitted inpatients. Interventions: Not applicable. Main Outcome Measures: The DSM-IV diagnostic criteria for delirium and the Delirium Rating Scale–Revised–98 (DRS-R98). Results: The diagnostic accuracy of the DSS was referenced against independently rated DSM-IV diagnostic criteria using receiver operating characteristic curves. The DSS obtained an area under the curve of .994 (P⬍.001). Concurrent validity was assessed by correlating severity and duration of delirium measured by the DSS with that measured by the DRS-R98. Pearson product moment correlations for both severity (r⫽⫺.913, P⬍.001) and duration (r⫽.975, P⬍.001) were highly significant. Conclusions: The DSS appears to be an accurate and valid measure of delirium following acquired brain injury. Key Words: Brain injuries; Delirium; Rehabilitation. Poster 4 Hypermetabolism Following Moderate-to-Severe Traumatic Acute Brain Injury: A Systematic Review. Norine Foley (Lawson Health Research Institute, London, ON), Shawn Marshall, Jill Pikul, Katherine Salter, Robert Teasell. Disclosure: None declared. Objective: To describe the pattern of energy expenditure during the first 30 days following traumatic brain injury (TBI). Data Sources: Medline, Embase, CINAHL, ISI Web of Science, and the Cochrane Library (1966 to December 2007). Study Selection: Trials that measured energy expenditure at least once during the first 30 days postinjury were included. Data Extraction: Data including patient characteristics, medical management, and details of metabolic measurements were abstracted independently by 2 reviewers. Results are reported descriptively. Data Synthesis: 24 studies were identified. During the first 30 days, mean energy expenditure expressed as a percentage of predicted value ranged from 75% to 200%. The lowest values were reported in patients admitted in brain death. The administration of paralyzing agents, sedatives, or barbiturates reduced metabolic rate by approximately 12% to 32%. Propranolol and morphine were also associated with smaller decreases in energy expenditure (5%, 8%, respectively). Steroid usage and method of feeding (enteral vs parenteral) did not appear to further elevate metabolic rate. It was unclear if elevated temperature, the presence of extracranial injury, or the severity of injury contributed further to hypermetabolism. Conclusions: Energy expenditure was significantly elevated in most patients following TBI, although the magnitude of the effect was highly variable. Key Words: Brain injuries; Rehabilitation. Arch Phys Med Rehabil Vol 89, October 2008