Does Neurologic Examination During Inpatient Rehabilitation Help Predict Global Outcome After Nonpenetrating Traumatic Brain Injury?

ObjectiveTo determine whether combining basic neurologic examination measurements with posttraumatic amnesia (PTA) duration can enhance prediction accuracy in moderate-to-severe traumatic brain injury (TBI).DesignA descriptive between-subjects study.SettingMulticenter: 4 Veterans Affairs Brain Injury Rehabilitation Centers within the Defense and Veterans Brain Injury Center network.ParticipantsA total of 210 patients (active duty, veteran, or military dependent) with moderate-to-severe nonpenetrating TBI who consented during acute rehabilitation for data collection and completed relevant baseline and 12-month follow-up evaluations.MethodsMultivariate analysis on neurologic examination predictor variables (upper extremity paresis, lower extremity paresis, Romberg test, and Kurtzke Expanded Disability Status Scale [EDSS]) was performed with block logistic regression modeling that controlled for duration of PTA.Main Outcome MeasureGlasgow Outcome Score at 1 year.ResultsGlasgow Outcome Score prediction accuracy by using PTA duration was modestly improved with the included neurologic examination measurements. The most influential predictor among them was EDSS, a composite measurement of neurologic impairment. When EDSS was excluded, the simple measurements of upper limb paresis and the Romberg test also provided independent prognostic value.ConclusionsThis study demonstrated that simple clinical measurements of neurologic impairment (limb paresis, imbalance, other neurologic deficits) are of value in refining the prediction of long-term global outcome from TBI. These measurements may serve as markers of focal injury not captured by PTA duration, a severity marker weighted toward diffuse injury.