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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Published Online First 18 December 2006
Competing interests: None.