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Prospective comparison of acute confusion severity with duration of posttraumatic amnesia in predicting employment outcome after traumatic brain injury
  1. Risa Nakase-Richardson (nakase{at}aol.com)
  1. Methodist Rehabilitation Center, United States
    1. Stuart A Yablon (doctory{at}earthlink.net)
    1. Methodist Rehabilitation Center, United States
      1. Mark Sherer (marks{at}mmrcrehab.org)
      1. Methodist Rehabilitation Center, United States

        Abstract

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

        Objective: Evaluate the contribution of severity of acute confusion at one-month post-TBI to prediction of employment at one-year post injury, comparing it with PTA duration.

        Methods: Prospective study involving 171 participants with complete data who met 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 severity of acute confusion. Evaluations closest to one-month post-injury were utilized for study purposes. PTA duration was defined as the interval from injury until two consecutive Galveston Orientation and Amnesia Test (GOAT) scores of ¡Ý76 were obtained within a period of 24-72 hours. Univariable and multivariable logistic regression were used to predict employment status at one-year post injury.

        Results: Age, education, and DelRS-R98 were significant predictors accounting for 34% of outcome variance. Individuals with greater confusion severity at one-month post injury, older age, and lower levels of education were less likely to be employed at one-year post-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.

        • confusion
        • employment
        • outcome
        • post-traumatic amnesia
        • traumatic brain injury

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