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Predicting Long-Term Global Outcome After TBI: Development of a Practical Prognostic Tool
e94 Research Poster 295511 WITHDRAWN
Research Poster 302295 Potential Predictors of Quality of Life in Patients with Stroke: A Follow-Up Study Tzu-Ling Chang (Chang Gung Memorial Hospital), Chia-Ling Chen, Chia-ying Chong Research Objectives: This study identifies predictors for quality of life (QOL) 6 months later in patients with stroke. Design: A longitudinal study with 6-month follow-up. Setting: This study recruited patients with stroke from the departments of physical medicine and rehabilitation of three tertiary hospitals (Taipei and Linkou branches of Chang Gung Memorial Hospital) and one regional hospital (Taoyuan branch). Participants: We enrolled 59 patients with stroke, age between 2377 years. Interventions: Not applicable. Main Outcome Measure(s): Nine potential predictors were examined at baseline: age; sex; stroke type; lesion side; Mini Mental State Examination (MMSE); Beck Depression Inventory-II; National Institutes of Health Stroke Scale (NIHSS); Brunstrom stage of upper limb distal part and lower limb. The QOL were assessed using Stroke Impact Scale (SIS) at 6-month follow-up. Results: Regression analysis revealed that Brunstrom stage of upper limb distal part was a main predictor for strength, ADL/IADL, mobility, hand function and total domains of SIS. The score of Beck Depression Inventory-II predicted memory, ADL/IADL and total domains of SIS. NIHSS score was a predictor of emotion and mobility domains. Furthermore, age, lesion side and types of stroke were associated with SIS scores. Conclusion/Discussion: The Brunstrom stage of upper limb distal part, BDI and NIHSS together may predict the QOL outcomes at 6-month follow-up for patients with stroke. These findings may allow clinicians to identify the patients who benefit most from therapy on QOL outcomes for these patients. Key Words: Stroke, Quality of Life, Predictors Disclosures: None. Research Poster 296648 WITHDRAWN
Research Poster 326799 Predicting Long-Term Global Outcome After TBI: Development of a Practical Prognostic Tool Adam Sima (Virginia Commonwealth University), William Walker, Katharine Stromberg, Jennifer Marwitz, Kristin Graham, Amma Agyemang, Jeffrey Kreutzer, Randall Merchant Research Objectives: To develop a prognostic tool for informative predictions on long-term functional outcomes after moderate to severe TBI. Design: Multiple Cross-Sectional Analyses at 1, 2, and 5 years post-injury. Setting: Inpatient rehabilitation facilities in multicenter TBI-Model Systems (TBIMS), with follow-up conducted primarily by telephone. Participants: Individuals with non-penetrating TBI and injury date 19972017 enrolled in the TBIMS.
Research Posters Interventions: Not applicable. Predictive models were built by a flexible classification tree methodology. Main Outcome Measure(s): Glasgow Outcome Scale. Results: There were 10,125, 8,821, and 6,165 participants in the final analyses for the 1, 2, and 5-year follow-up periods, respectively. PTA duration dominated the branching hierarchy in all model years, with similar cutoffs in each of the follow-up periods. Lower order variables used as prognostication variables included age at injury, premorbid education, occupational category, and productivity, with age at injury being the most proximal predictor when more than one emerged. Generally, patients who spent fewer days in PTA, were younger at injury, employed or productive, and had achieved higher levels of education had better outcomes. Prior TBI, problem alcohol use, illicit drug use, initial motor GCS, focal hemorrhage on CT, cranial surgery, and acute hospital LOS were non-contributory. Predictability in independent test datasets ranged from C-statistic of 0.685 (year-5) to 0.729 (year-2). Conclusion/Discussion: An easy-to-use prognostic tool for long-term functional outcomes was developed that is based on flexible statistical methodology and a large number of patients. An assessment using an independent dataset showed reasonable predictability, allowing for its use to guide expectations for patients and their families. Findings show that up to 5 years after moderate to severe TBI, length of PTA, a correlate of injury severity, remains the most critical determinant of functional outcomes. Key Words: Post-Injury Prognostication, Traumatic Brain Injury, GOS, TBIMS Disclosures: Nothing to disclose. Research Poster 302005 Prediction Patterns of Emergence from Pediatric Disorders of Consciousness Sarah Lahey (Brooks Rehabilitation), Cynthia Beaulieu Research Objectives: Research in pediatric disorders of consciousness (DoC) lags behind research in adult DoC. Very limited information is available regarding characteristics, predictors, or outcomes of pediatric DoC. Aims of the current study include: 1) To describe the characteristics of the pediatric patient population admitted to a specialty program for DoC 2) To identify predictors of emergence from pediatric DoC. Design: Single center, retrospective, observational study using electronic medical records. Setting: Acute inpatient rehabilitation facility. Participants: Patients (NZ48) ages 3 to 18 years with suspected DoC admitted to a specialized program in inpatient rehabilitation during the acute recovery phase ( < 6 months) following severe brain injury. Injury etiology included non-traumatic brain injury (nTBI, nZ18, 38%) or traumatic brain injury (TBI, nZ30, 62%). Of the participants, 33 (69%) were determined to be in the VS and 15 (31%) were in the MCS at admission. Interventions: Not applicable. Main Outcome Measure(s): Emergence from DoC. Results: A logistic regression analysis was conducted using age, etiology (TBI, nTBI), and DoC diagnosis following admission as the predictors. The admission diagnosis reliably distinguished between patients that emerged from DoC and those who did not (chi square Z 10.1, p < .01). The pattern of prediction was similar for both VS and MCS regardless of etiology (i.e., TBI vs. nTBI). Likelihood of emergence increased with age, with the youngest patients (age < 5 yrs) having the poorest prognosis. Conclusion/Discussion: These findings represent one of the largest samples of pediatric DoC and show the feasibility of improving outcome prediction using readily available clinical variables. Pattern of prediction may signify unique prognostic issues within pediatric DoC compared to adult counterparts. Future directions will be discussed. Key Words: Pediatric, Brain Injury, Disorders of Consciousness, Acute Rehabilitation, Neuropsychology Disclosures: None.
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Research Poster 302295 Potential Predictors of Quality of Life in Patients with Stroke: A Follow-Up Study Tzu-Ling Chang (Chang Gung Memorial Hospital), Chia-Ling Chen, Chia-ying Chong Research Objectives: This study identifies predictors for quality of life (QOL) 6 months later in patients with stroke. Design: A longitudinal study with 6-month follow-up. Setting: This study recruited patients with stroke from the departments of physical medicine and rehabilitation of three tertiary hospitals (Taipei and Linkou branches of Chang Gung Memorial Hospital) and one regional hospital (Taoyuan branch). Participants: We enrolled 59 patients with stroke, age between 2377 years. Interventions: Not applicable. Main Outcome Measure(s): Nine potential predictors were examined at baseline: age; sex; stroke type; lesion side; Mini Mental State Examination (MMSE); Beck Depression Inventory-II; National Institutes of Health Stroke Scale (NIHSS); Brunstrom stage of upper limb distal part and lower limb. The QOL were assessed using Stroke Impact Scale (SIS) at 6-month follow-up. Results: Regression analysis revealed that Brunstrom stage of upper limb distal part was a main predictor for strength, ADL/IADL, mobility, hand function and total domains of SIS. The score of Beck Depression Inventory-II predicted memory, ADL/IADL and total domains of SIS. NIHSS score was a predictor of emotion and mobility domains. Furthermore, age, lesion side and types of stroke were associated with SIS scores. Conclusion/Discussion: The Brunstrom stage of upper limb distal part, BDI and NIHSS together may predict the QOL outcomes at 6-month follow-up for patients with stroke. These findings may allow clinicians to identify the patients who benefit most from therapy on QOL outcomes for these patients. Key Words: Stroke, Quality of Life, Predictors Disclosures: None. Research Poster 296648 WITHDRAWN
Research Poster 326799 Predicting Long-Term Global Outcome After TBI: Development of a Practical Prognostic Tool Adam Sima (Virginia Commonwealth University), William Walker, Katharine Stromberg, Jennifer Marwitz, Kristin Graham, Amma Agyemang, Jeffrey Kreutzer, Randall Merchant Research Objectives: To develop a prognostic tool for informative predictions on long-term functional outcomes after moderate to severe TBI. Design: Multiple Cross-Sectional Analyses at 1, 2, and 5 years post-injury. Setting: Inpatient rehabilitation facilities in multicenter TBI-Model Systems (TBIMS), with follow-up conducted primarily by telephone. Participants: Individuals with non-penetrating TBI and injury date 19972017 enrolled in the TBIMS.
Research Posters Interventions: Not applicable. Predictive models were built by a flexible classification tree methodology. Main Outcome Measure(s): Glasgow Outcome Scale. Results: There were 10,125, 8,821, and 6,165 participants in the final analyses for the 1, 2, and 5-year follow-up periods, respectively. PTA duration dominated the branching hierarchy in all model years, with similar cutoffs in each of the follow-up periods. Lower order variables used as prognostication variables included age at injury, premorbid education, occupational category, and productivity, with age at injury being the most proximal predictor when more than one emerged. Generally, patients who spent fewer days in PTA, were younger at injury, employed or productive, and had achieved higher levels of education had better outcomes. Prior TBI, problem alcohol use, illicit drug use, initial motor GCS, focal hemorrhage on CT, cranial surgery, and acute hospital LOS were non-contributory. Predictability in independent test datasets ranged from C-statistic of 0.685 (year-5) to 0.729 (year-2). Conclusion/Discussion: An easy-to-use prognostic tool for long-term functional outcomes was developed that is based on flexible statistical methodology and a large number of patients. An assessment using an independent dataset showed reasonable predictability, allowing for its use to guide expectations for patients and their families. Findings show that up to 5 years after moderate to severe TBI, length of PTA, a correlate of injury severity, remains the most critical determinant of functional outcomes. Key Words: Post-Injury Prognostication, Traumatic Brain Injury, GOS, TBIMS Disclosures: Nothing to disclose. Research Poster 302005 Prediction Patterns of Emergence from Pediatric Disorders of Consciousness Sarah Lahey (Brooks Rehabilitation), Cynthia Beaulieu Research Objectives: Research in pediatric disorders of consciousness (DoC) lags behind research in adult DoC. Very limited information is available regarding characteristics, predictors, or outcomes of pediatric DoC. Aims of the current study include: 1) To describe the characteristics of the pediatric patient population admitted to a specialty program for DoC 2) To identify predictors of emergence from pediatric DoC. Design: Single center, retrospective, observational study using electronic medical records. Setting: Acute inpatient rehabilitation facility. Participants: Patients (NZ48) ages 3 to 18 years with suspected DoC admitted to a specialized program in inpatient rehabilitation during the acute recovery phase ( < 6 months) following severe brain injury. Injury etiology included non-traumatic brain injury (nTBI, nZ18, 38%) or traumatic brain injury (TBI, nZ30, 62%). Of the participants, 33 (69%) were determined to be in the VS and 15 (31%) were in the MCS at admission. Interventions: Not applicable. Main Outcome Measure(s): Emergence from DoC. Results: A logistic regression analysis was conducted using age, etiology (TBI, nTBI), and DoC diagnosis following admission as the predictors. The admission diagnosis reliably distinguished between patients that emerged from DoC and those who did not (chi square Z 10.1, p < .01). The pattern of prediction was similar for both VS and MCS regardless of etiology (i.e., TBI vs. nTBI). Likelihood of emergence increased with age, with the youngest patients (age < 5 yrs) having the poorest prognosis. Conclusion/Discussion: These findings represent one of the largest samples of pediatric DoC and show the feasibility of improving outcome prediction using readily available clinical variables. Pattern of prediction may signify unique prognostic issues within pediatric DoC compared to adult counterparts. Future directions will be discussed. Key Words: Pediatric, Brain Injury, Disorders of Consciousness, Acute Rehabilitation, Neuropsychology Disclosures: None.
www.archives-pmr.org