Severe TBI Outcome Prediction: Usefulness of FIM Scores during Inpatient Rehabilitation (P01.187)

Abstract

Objective: The goal of this study is to examine possible clinical predictors related to exceptional long-term functional outcomes in severe truamatic brain injury(STBI). Background Long-standing impairments are commonplace following STBI. There is plentiful literature on clinical predictors following STBI, but cases of greater than expected recovery following STBI have not as yet been a focus for research. Design/Methods: Case report series of three female participants with STBI initially admitted to inpatient rehabilitation(IR). Participants had initial Glascow Coma Scale scores of 3, post-traumatic amnesia durations of 18-115 days, time to follow commands of 16-100 days, abnormal initial brain CT scans, and initial pupil abnormalities. Outpatient rehabilitation ranged from three to six months. All resumed major life roles (gainful employment, ability to drive, ability to live independently). Participant IR Functional Independence Measure(FIM) score improvements were compared to national normative STBI FIM data from National Data Systems (NDS) for 2010 (n = 15,808). Results: All three participants were involved in gainful employment, resumed driving, and were living independently by 12 months post-injury. Initial FIM scores ranged from 12 to 42 (χ = 28; NDS = 51.8) with discharge scores ranging from 39 to 76 (χ = 59; NDS = 79.3). Total FIM gain from IR admission to discharge ranged from 27 to 34 points (χ = 31; NDS = 27.5). Cognitive FIM rating improved an average of 13.7 points, compared to 5.9 points for NDS. Sphincter (bowel and bladder) FIM rating improved an average of 5 points, compared to 3 points for NDS. Conclusions: IR FIM score changes may be useful in long-term STBI outcome prediction All three participants demonstrated marked improvements in FIM scores during inpatient rehabilitation and subsequent resumption of major life domains. Further research is necessary to validate whether sphincter and cognitive FIM score changes may be useful in long-term STBI outcome prediction. Disclosure: Dr. Kushner has nothing to disclose. Dr. Johnson-Greene has nothing to disclose.