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Abstract
Post-traumatic amnesia (PTA) is characterized by a state of disorientation and confusion following traumatic brain injury (TBI). Few studies have looked at the effect of prolonged PTA on the functional outcomes beyond 1 year post-injury. This study aims to evaluate the burden of care in individuals with extremely severe PTA (esPTA; PTA >28 days) from acute inpatient rehabilitation admission to 5 years post-injury as well as the association between intracranial hypertension (ICH; Intracranial pressure (ICP) ≥20 mmHg) and esPTA status. Three hundred and forty-two individuals with moderate to severe TBI enrolled in the Northern California TBI Model System (TBIMS) of Care were included in this study. The FIM® instrument was chosen as the outcome measurement as it is a widely used functional assessment in the rehabilitation community. Repeated measure ANOVA revealed greater burden of care based on FIM® total scores (p < 0.001) from admission to 5-year follow-up for the esPTA group compared to the non-esPTA group (PTA ≤ 28 days). Unlike the non-esPTA group where FIM® total score plateaued 1 year post-injury, FIM® total score continued to improve up to 2 years post-injury for the esPTA group. The odds of developing esPTA was ~3 times higher for individuals with ICH vs. individuals without ICH (p < 0.001). In conclusion, individuals with esPTA have increased short- and long-term burden of care and the presence of ICH during hospitalization increased the odds of experiencing esPTA. These results may help the rehabilitation team and family in planning care post rehabilitation discharge.
Highlights
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide [1]
Based on the Uniform Data System’s classification of FIM scores (Figure 2), the results of this study reveal individuals with extremely severe PTA (esPTA) on average require approximately twice as many hours of care across assessment periods compared to non-esPTA individuals
The increased burden of care continued at discharge with the esPTA group requiring 2–3 h of care compared to the non-esPTA group requiring 1–2 h of care
Summary
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide [1]. In addition to the financial impact, given the increased burden of care faced by caregivers of patients with TBI, it is not surprising that caregivers report being “overburdened with responsibilities” [4] and suffer from a high level of caregiver distress [5]. These factors highlight the importance of TBI research to improve early diagnosis, prognosis, and treatment to maximize functional recovery and reduce the burden of care for individuals with TBI
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