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Prospective comparison of acute confusion severity with duration of post-traumatic amnesia in predicting employment outcome after traumatic brain injury
  1. Risa Nakase-Richardson,
  2. Stuart A Yablon,
  3. Mark Sherer
  1. Brain Injury Program, Methodist Rehabilitation Center, Jackson, Mississippi, USA
  1. Correspondence to:
 Dr Risa Nakase-Richardson
 Methodist Rehabilitation Center, Department of Neuropsychology, 1350 East Woodrow Wilson Drive, Jackson, Mississippi 39216, USA; nakase{at}aol.com

Abstract

Background: Measurement of the duration of post-traumatic amnesia (PTA) is common practice, serving as an important index of the severity of traumatic brain injury (TBI) and a predictor of functional outcome. However, controversy exists regarding the nature of PTA; some studies indicate that it is a confusional state with symptoms that extend beyond disorientation and amnesia.

Objective: To evaluate the contribution of the severity of acute confusion 1 month after TBI to prediction of employment at 1 year after injury, comparing it with PTA duration.

Methods: Prospective study involving 171 participants with complete data, who met the study criteria, from 228 consecutive TBI Model System admissions. Outcome measures included weekly administration of the Delirium Rating Scale-Revised-98 (DelRS-R98) to measure the severity of acute confusion. Evaluations closest to 1 month after injury were used for study purposes. Duration of PTA was defined as the interval from injury until two consecutive Galveston Orientation and Amnesia Test scores of ⩾76 were obtained within a period of 24–72 h. Univariable and multivariable logistic regression were used to predict employment status at 1 year after injury.

Results: Age, education and DelRS-R98 were significant predictors accounting for 34% of outcome variance. Individuals with greater confusion severity at 1 month after injury, older age and lower levels of education were less likely to be employed at 1 year after injury. Severity of confusion was more strongly associated with employment outcome (rs = −0.39) than was PTA duration (rs = −0.34).

Conclusions: In addition to demographic indices, severity of acute confusion makes a unique contribution to predicting late outcome after TBI.

  • DDC, delirium diagnostic criteria
  • DelRS-R98, Delirium Rating Scale-Revised-98
  • GCS, Glasgow Coma Scale
  • GOAT, Galveston Orientation and Amnesia Test
  • IRC, interquartile range coefficients
  • PTA, post-traumatic amnesia
  • TBI, traumatic brain injury

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Footnotes

  • Published Online First 18 December 2006

  • Competing interests: None.

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