Comorbid Traumatic Brain Injury and Spinal Cord Injury: Screening Validity and Effect on Outcomes

Abstract

ObjectivesTo determine the diagnostic accuracy of a self-report measure of traumatic brain injury (TBI) in people with spinal cord injury (SCI), and to assess the potential effect of TBI on acute and postacute outcomes. DesignIncident TBI as determined by self-report was compared with systematic medical records review by physicians blinded to self-reported TBI. SettingInpatient rehabilitation unit. ParticipantsFrom 155 consecutive admissions, participants (N=105; 73% men; mean age, 45.9y; 73% white; 58% with tetraplegia) who met inclusion criteria and were admitted on the day of injury were recruited and assessed. InterventionsNot applicable. Main Outcome MeasureStep 2 of the Traumatic Brain Injury-4 (TBI-4) interview was used to estimate the presence and severity of TBI. ResultsEstimated incidence of TBI was 33% by chart review and 60% based on Step 2 of the TBI-4. Ninety-one percent of those with TBI based on chart review sustained mild injuries. At the optimal cutoff of “possible TBI,” the TBI-4 had a sensitivity of 83% (95% confidence interval, 66%–93%), a specificity of 51% (95% confidence interval, 39%–64%), and a Youden Index of 0.3 (95% confidence interval, 0.2–0.5). Compared with those without TBI, those with chart review–determined TBI had nonsignificant trends toward a longer acute care length of stay and a higher functional status at rehabilitation discharge, but equivalent 1-year outcomes. ConclusionsStep 2 of theTBI-4 did not meet Youden's criteria (≥0.8) for good diagnostic accuracy in the context of recent SCI. Comorbid TBIs were almost exclusively mild and not associated with poorer outcomes 1 year after SCI.