Prevalence of Depression and Anxiety Disorders Following Mild Traumatic Brain Injury: A Retrospective Cohort Study

e96 ischemic stroke had been prescribed anti-thrombotic medication (when indicated). Design: The Stroke Foundation (Australia) National Stroke Audit included hospitals that audited consecutive admitted cases using the Australian Stroke Data Tool (AuSDaT). Re-audits of a subset of cases by a second clinician and program data logic checks ensured the reliability and validity of data, with discrepancies clarified with each facility. Setting: Hospital inpatient facilities (nZ112) from all states of Australia. Participants: Adults admitted to hospital with a new episode of ischemic stroke (nZ3121) were included in the analyses. Patients not discharged directly to the community or for whom anti-thrombotic medication was not considered appropriate were excluded from analyses. Interventions: Routine multidisciplinary care. Main Outcome Measure(s): Whether anti-thrombotic medication was prescribed to patients prior to discharge from hospital. Results: Multi-level generalized linear modelling (patients clustered in hospitals) identified patients who had received care in a specialized stroke unit were more likely to have been prescribed anti-thrombotic medication Odds Ratio (OR) 1.86 (95%CI 0.98, 3.56) as were patients taking antithrombotic medication prior their acute stroke 2.35 (95%CI 2.35, 4.43). Patients identified as having a cognitive impairment OR 0.16 (95%CI 0.08, 0.30), and patients who experienced a fever during their hospitalization OR 0.29 (95%CI 0.12, 0.71) were less likely to have been prescribed antithrombotic medication. The proportion of variation attributable to differences between hospitals (rather than individual cases) was approximately 11% (95%CI 1%, 43%). Conclusion/Discussion: Understanding patient and clinical factors associated with prescription of anti-thrombotic medications may be useful for developing targeted practice-change interventions to improve adherence with evidence based secondary prevention clinical practice guidelines following acute ischemic stroke. Key Words: Stroke, Medication, Quality Of Health Care, Secondary Prevention, Ischemic Disclosures: None. Research Poster 305189 Prevalence of Depression and Anxiety Disorders Following Mild Traumatic Brain Injury: A Retrospective Cohort Study Richard Delmonico (Kaiser Foundation Rehabilitation Center), Brian Theodore, Elizabeth Sandel, Mary Anne Armstrong, Michelle Camicia Research Objectives: To determine the prevalence and relative risk of post-injury affective disorders over 4 years following mild Traumatic Brain Injury (mTBI) among adult members of a large health maintenance organization. Design: Matched cohort study of mTBI cases and matched controls, over a 4-year period. Setting: An integrated health care system in northern California. Participants: 9,428 adult health plan members diagnosed with mTBI from 2000-2007 and enrolled in the year prior to injury, during which no TBI was ascertained. Control subjects included 18,856 individuals. These subjects were selected based on the following criteria: Two unexposed health plan members per each mTBI-exposed patient were randomly selected as comparisons, matched for age, sex, race/ethnicity, and reference date. Interventions: Not applicable. Main Outcome Measure(s): A diagnosis of affective disorder (anxiety, depression or adjustment disorder with mixed features) in the 4 years after mTBI, determined according to the International Classification of Diseases, Ninth Revision, Clinical Modification, 9th Edition ICD-9-CM as well as the Diagnostic and Statistical Manual 4th TR Edition. Results: The prevalence for affective disorders was most prominent during the first 12 months, and was 43% following mTBI and 29% in the control

Research Posters group. Four-year aggregate adjusted relative risk for developing an affective disorder following mTBI was 1.5 (95% CI: 1.5-1.6; p < .001) and 1.4 (95% CI: 1.3-1.5; p < .001) for patients with and without prior psychiatric diagnoses, respectively. Conclusion/Discussion: mTBI was associated with a significantly increased risk of developing subsequent affective disorders, when compared with controls matched by gender, age, and race/ethnicity. The risk for developing an affective disorder is highest during the first 12 months following mTBI. Key Words: Mild Traumatic Brain Injury, Depression, Anxiety Disorders, Retrospective Cohort Study Disclosures: None. Research Poster 299788 Prevalence of Vitamin D Deficiency in an Inpatient Rehabilitation Facility Benjamin Abramoff (Emory University), Christine Krull, Yogita Tailor Research Objectives: To evaluate the prevalence of VDD and the efficacy of a standardized vitamin D screening and supplementation protocol at a diverse acute inpatient rehabilitation facility. Design: This cohort study included two groups: patients admitted in the two months prior to intervention, and patients admitted in the two months after intervention. The intervention included a universal serum 25-OH vitamin D test for each patient admitted and a standard cholecalciferol supplementation protocol based on serum vitamin D level and BMI. Vitamin D insufficiency was defined as 20-29.9 ng/mL and deficiency as < 20 ng/mL. A subgroup analysis was also performed. Setting: Free-standing academic acute rehabilitation hospital. Participants: 127 patients and the post-intervention group included 129 patients who were admitted for acute inpatient rehabilitation. Interventions: The intervention included a universal serum 25-OH vitamin D test for each patient admitted and a standard cholecalciferol supplementation protocol based on serum vitamin D level and BMI. Main Outcome Measure(s): Vitamin D insufficiency was defined as 2029.9 ng/mL and deficiency as < 20 ng/mL. A subgroup analysis was also performed. Results: Pre-intervention, 11% of admitted patients were screened for VDD. 67% of those patients were found to be vitamin D insufficient (21%) or deficient (43%). Post-intervention, 91% of admitted patients were screened. 78% of those patients were found to be vitamin D insufficient (31%) or deficient (47%). Pre-intervention, 3% of admitted patients were started on or had increased supplementation based on screening results vs. 53% post-intervention. Conclusion/Discussion: Vitamin D deficiency is highly prevalent in a diverse acute inpatient rehabilitation hospital. A routine screening and standardized supplementation protocol may be a good practice to improve quality of patient care. Future studies are needed to evaluate the efficacy of this intervention on long-term outcomes. Key Words: Vitamin D, Acute Rehabilitation, Quality Improvement Disclosures: None. Research Poster 308813 Propensity Score Matching Methods For Rasch Common-Person Equating Requirement: A Feasibility Study Ickpyo Hong (University of Texas Medical Branch), Timothy Reistetter Research Objectives: To test if the Propensity Score (PS) matching method supports the unidimensionality assumption of the Rasch model, which would support use of PS models when the common-person approach is not plausible. Design: A secondary analysis of a cross-sectional national survey. Survey sample were matched based on their total score category (high and low) using a 1:1 Greedy PS matching method. The samples were matched using

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