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Poster 481: Alcohol Withdrawal and Early Outcomes Following Inpatient Rehabilitation for Traumatic Brain Injury
S286
Abstracts / PM R 9 (2017) S131-S290
discharge. Among those with a reported psychosocial health related quality of life score, 135 had a score at baseline, 130 at admission, and 64 reported post-discharge. The cohort was between ages 4-21, primarily Caucasian, male, and English speaking. Patient and familyreported physical HRQOL improved significantly from the time of rehabilitation admission to outpatient follow-up (mean score 20.2 to 59.7, P<.001). Psychosocial HRQOL improved, though to a lesser extent (mean score 55.8 to 71.2, P<.001). Conclusions: Patient and family-reported physical and psychosocial HRQOL, which are impacted significantly by new functional impairment, are seen to improve significantly through a course of inpatient rehabilitation. Despite significant loss to follow-up, we were able to determine the magnitude of change was greater than the 10-point decrement previously clinically correlated with an increase in 30-day readmissions and emergency department return visits. Inpatient rehabilitation is associated with important benefits for perceived HRQOL. Level of Evidence: Level III
CATEGORY: NEUROLOGICAL REHABILITATION
Poster 481: Alcohol Withdrawal and Early Outcomes Following Inpatient Rehabilitation for Traumatic Brain Injury Russell Lacey, MD (Virginia Commonwealth Univ Hlth Sys, Richmond, VA, United States) Disclosures: Russell Lacey: I Have No Relevant Financial Relationships To Disclose Objective: To compare inpatient rehabilitation outcomes for individuals with traumatic brain injury (TBI) based on whether they were also managed for symptoms of alcohol withdrawal during acute care. Design: Observational research, retrospective chart review. Setting: Level I trauma center, acute care and inpatient rehabilitation. Participants: Patients who completed inpatient rehabilitation for moderate-to-severe TBI and who were enrolled in the TBI model systems at the study site (n¼234). A retrospective chart review determined which patients were managed for alcohol withdrawal using the Clinical Institute Withdrawal Assessment (CIWA) protocol. Patients were divided into two groups: TBI-only (n¼167) and TBI+CIWA (n¼67). Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale (DRS). Results: The two groups were comparable with no significant differences related to initial injury severity, length of posttraumatic amnesia (PTA), gender, years of education, acute care length of stay (LOS), rehabilitation LOS, and DRS scores at admission to rehabilitation. However, subjects in the TBI+CIWA group were significantly (P¼.050) older (M¼45.9, SD¼12.3) than those in the TBI-only group (M¼40.9, SD¼19.2). There was a significant difference between groups for DRS scores at discharge (F(1,227)¼4.050, P¼.045), with the TBI+CIWA group having lower scores (M¼6.4, SD¼1.9) compared to the TBIonly group (M¼7.0, SD¼2.2). Conclusions: Despite being similar on measures of initial injury severity and functional status at admission to inpatient rehabilitation, the TBI+CIWA group had significantly lower DRS scores (i.e., less overall disability) at discharge compared to the TBI-only group. These findings suggest that individuals recovering from TBI who were also managed for alcohol withdrawal may have a more favorable initial recovery trajectory than those with TBI-only. It is also possible that initial injury severity indicators (e.g., PTA) may be confounded with symptoms of alcohol withdrawal or withdrawal management resulting in overestimation of injury severity. Level of Evidence: Level II
CATEGORY: QUALITY IMPROVEMENT
Poster 482: Feasibility of an Audit System for Canadian Sonographers in Generalist Ultrasound Robert Dima, none (McMaster University, Grimsby, ON, Canada), Calin Vasile, BSc Medical Science, RDMS, RVT, CRGS, CRCS, CRVS, Vinicius Tieppo Francio, MD/PhD(c) Disclosures: Robert Dima: I Have No Relevant Financial Relationships To Disclose Objective: To develop and assess the feasibility of a working audit model for generalist medical sonographers in Canada. The rapid growth and development of the dynamic field of sonography highlights the importance to produce quantitative evidence for Canadian sonographer’s ability in the current healthcare environment. The audit method was employed to measure performance and identify targets of change, setting a template for further large scale investigations which may, in the future, influence and inform considerations involving role expansion of sonographers in Canada. Design: Quantitative literature review. Setting: Radiological Sciences Department of a Canadian Health Care Institution. Participants: 429 subjects. Interventions: An audit method of 433 generalist ultrasound exams was performed in the Radiological Sciences Department of a Canadian healthcare institution. Technologist reports were contrasted with radiologist final reports and a degree of agreement (DoA) was assigned for each exam package by content analysis. Main Outcome Measures: N/A. Results: 75% (322/429) exam packages were ranked as DoA 1 (greatest agreement between sonographer and radiologist), 20% (86/429) were ranked as DoA 2, 4% (16/429) were ranked as DoA 3 and 1% (5/429) were ranked as DoA 4 (significant discrepancy between sonographer and radiologist). No definite trends in agreement between sonographer and radiologist based on the type of exam being performed were evident. Conclusions: The findings reveal good (75%) agreement between sonographer and radiologist on imaging findings as they are recorded in the technical impression sheets and radiologist reports. When discrepancies arise, they are usually minor and involve the omission of incidental/additional findings by the radiologist. The methods employed in this study may be suitable for large-scale audits of sonographer performance and reporting practices, as individual review of images may present significant logistical challenges. Level of Evidence: Level IV
CATEGORY: PAIN & SPINE MEDICINE
Poster 483: Immediate vs. Prolonged Pain Relief After Sacroiliac Joint Injection with Anesthetic and Corticosteroid: A Prospective Study David J. Kennedy, MD (Stanford University, Redwood City, CA, United States), Charles A. Odonkor, MD, MA, Patricia Z. Zheng, MD, Byron J. Schneider, MD, Lisa Huynh, MD, Joshua Levin, MD, Ramin Kordi, MD PhD Disclosures: David Kennedy: I Have No Relevant Financial Relationships To Disclose Objective: To determine the relationship of immediate and short term responses to an injection into the sacroiliac joint (SIJ) at predicting pain at 6 months.
Abstracts / PM R 9 (2017) S131-S290
discharge. Among those with a reported psychosocial health related quality of life score, 135 had a score at baseline, 130 at admission, and 64 reported post-discharge. The cohort was between ages 4-21, primarily Caucasian, male, and English speaking. Patient and familyreported physical HRQOL improved significantly from the time of rehabilitation admission to outpatient follow-up (mean score 20.2 to 59.7, P<.001). Psychosocial HRQOL improved, though to a lesser extent (mean score 55.8 to 71.2, P<.001). Conclusions: Patient and family-reported physical and psychosocial HRQOL, which are impacted significantly by new functional impairment, are seen to improve significantly through a course of inpatient rehabilitation. Despite significant loss to follow-up, we were able to determine the magnitude of change was greater than the 10-point decrement previously clinically correlated with an increase in 30-day readmissions and emergency department return visits. Inpatient rehabilitation is associated with important benefits for perceived HRQOL. Level of Evidence: Level III
CATEGORY: NEUROLOGICAL REHABILITATION
Poster 481: Alcohol Withdrawal and Early Outcomes Following Inpatient Rehabilitation for Traumatic Brain Injury Russell Lacey, MD (Virginia Commonwealth Univ Hlth Sys, Richmond, VA, United States) Disclosures: Russell Lacey: I Have No Relevant Financial Relationships To Disclose Objective: To compare inpatient rehabilitation outcomes for individuals with traumatic brain injury (TBI) based on whether they were also managed for symptoms of alcohol withdrawal during acute care. Design: Observational research, retrospective chart review. Setting: Level I trauma center, acute care and inpatient rehabilitation. Participants: Patients who completed inpatient rehabilitation for moderate-to-severe TBI and who were enrolled in the TBI model systems at the study site (n¼234). A retrospective chart review determined which patients were managed for alcohol withdrawal using the Clinical Institute Withdrawal Assessment (CIWA) protocol. Patients were divided into two groups: TBI-only (n¼167) and TBI+CIWA (n¼67). Interventions: Not applicable. Main Outcome Measures: Disability Rating Scale (DRS). Results: The two groups were comparable with no significant differences related to initial injury severity, length of posttraumatic amnesia (PTA), gender, years of education, acute care length of stay (LOS), rehabilitation LOS, and DRS scores at admission to rehabilitation. However, subjects in the TBI+CIWA group were significantly (P¼.050) older (M¼45.9, SD¼12.3) than those in the TBI-only group (M¼40.9, SD¼19.2). There was a significant difference between groups for DRS scores at discharge (F(1,227)¼4.050, P¼.045), with the TBI+CIWA group having lower scores (M¼6.4, SD¼1.9) compared to the TBIonly group (M¼7.0, SD¼2.2). Conclusions: Despite being similar on measures of initial injury severity and functional status at admission to inpatient rehabilitation, the TBI+CIWA group had significantly lower DRS scores (i.e., less overall disability) at discharge compared to the TBI-only group. These findings suggest that individuals recovering from TBI who were also managed for alcohol withdrawal may have a more favorable initial recovery trajectory than those with TBI-only. It is also possible that initial injury severity indicators (e.g., PTA) may be confounded with symptoms of alcohol withdrawal or withdrawal management resulting in overestimation of injury severity. Level of Evidence: Level II
CATEGORY: QUALITY IMPROVEMENT
Poster 482: Feasibility of an Audit System for Canadian Sonographers in Generalist Ultrasound Robert Dima, none (McMaster University, Grimsby, ON, Canada), Calin Vasile, BSc Medical Science, RDMS, RVT, CRGS, CRCS, CRVS, Vinicius Tieppo Francio, MD/PhD(c) Disclosures: Robert Dima: I Have No Relevant Financial Relationships To Disclose Objective: To develop and assess the feasibility of a working audit model for generalist medical sonographers in Canada. The rapid growth and development of the dynamic field of sonography highlights the importance to produce quantitative evidence for Canadian sonographer’s ability in the current healthcare environment. The audit method was employed to measure performance and identify targets of change, setting a template for further large scale investigations which may, in the future, influence and inform considerations involving role expansion of sonographers in Canada. Design: Quantitative literature review. Setting: Radiological Sciences Department of a Canadian Health Care Institution. Participants: 429 subjects. Interventions: An audit method of 433 generalist ultrasound exams was performed in the Radiological Sciences Department of a Canadian healthcare institution. Technologist reports were contrasted with radiologist final reports and a degree of agreement (DoA) was assigned for each exam package by content analysis. Main Outcome Measures: N/A. Results: 75% (322/429) exam packages were ranked as DoA 1 (greatest agreement between sonographer and radiologist), 20% (86/429) were ranked as DoA 2, 4% (16/429) were ranked as DoA 3 and 1% (5/429) were ranked as DoA 4 (significant discrepancy between sonographer and radiologist). No definite trends in agreement between sonographer and radiologist based on the type of exam being performed were evident. Conclusions: The findings reveal good (75%) agreement between sonographer and radiologist on imaging findings as they are recorded in the technical impression sheets and radiologist reports. When discrepancies arise, they are usually minor and involve the omission of incidental/additional findings by the radiologist. The methods employed in this study may be suitable for large-scale audits of sonographer performance and reporting practices, as individual review of images may present significant logistical challenges. Level of Evidence: Level IV
CATEGORY: PAIN & SPINE MEDICINE
Poster 483: Immediate vs. Prolonged Pain Relief After Sacroiliac Joint Injection with Anesthetic and Corticosteroid: A Prospective Study David J. Kennedy, MD (Stanford University, Redwood City, CA, United States), Charles A. Odonkor, MD, MA, Patricia Z. Zheng, MD, Byron J. Schneider, MD, Lisa Huynh, MD, Joshua Levin, MD, Ramin Kordi, MD PhD Disclosures: David Kennedy: I Have No Relevant Financial Relationships To Disclose Objective: To determine the relationship of immediate and short term responses to an injection into the sacroiliac joint (SIJ) at predicting pain at 6 months.