A comparison of substance abuse and violence in the prediction of long-term rehabilitation outcomes after traumatic brain injury.

OBJECTIVE

To determine the relative contributions of substance abuse history and violent etiology to the prediction of outcomes for individuals who sustained a traumatic brain injury (TBI) requiring inpatient rehabilitation.

DESIGN

Longitudinal study of outcomes 1 year postdischarge from rehabilitation.

SETTING

Specialized TBI acute rehabilitation unit.

PARTICIPANTS

Three hundred fifty-one individuals consecutively admitted for rehabilitation.

INTERVENTIONS

Gathered data from patients' medical records (including etiology of injury, initial Glasgow Coma Scale scores, and FIMtrade mark instrument scores at discharge), demographic details, and history of substance abuse; phone and mail survey data from individuals (Satisfaction with Life Scale [SWLS]; Community Integration Questionnaire [CIQ]).

MAIN OUTCOME MEASURES

CIQ and SWLS; relative contributions of injury etiology, demographic and injury-related dependent variables, and substance abuse history to predictive model.

RESULTS

Almost 80% of persons with injuries from violence-related causes had a history of substance abuse. Substance abuse was found to contribute to the prediction of life satisfacton and productivity, while violent etiology was not a significant contributor to predictive models.

CONCLUSION

Substance abuse history proved to be a strong predictor of long-term outcomes, while violent etiology of injury was less influential. The results of this study emphasize the need to include substance abuse history in all studies of outcomes after TBI, and to increase prevention efforts to limit the effects of such a history.