Bradbury Cheryl L, Wodchis Walter P, Mikulis David J, Pano Ephrem G, Hitzig Sander L, McGillivray Colleen F, Ahmad Fahad N, Craven B Catherine, Green Robin E
Toronto Rehabilitation Institute, Toronto, ON, Canada.
Arch Phys Med Rehabil. 2008 Dec;89(12 Suppl):S77-84. doi: 10.1016/j.apmr.2008.07.008.
To evaluate the clinical and economic burden of traumatic brain injury (TBI) in people with traumatic spinal cord injury (SCI).
Prospective, case-matched control study.
Inpatient spinal cord rehabilitation program.
Patients (n=10) diagnosed with traumatic SCI and concomitant TBI matched to an SCI only control group.
Not applicable.
Inpatient rehabilitation length of stay, health care costs (patient care hours), clinician resource allocation, behavioral and critical incidents, FIM, Personality Assessment Inventory, and neuropsychological assessment findings.
Prolonged loss of consciousness, increased rehabilitation costs, and greater demands on clinician recourses (trend) were found in the SCI with TBI group relative to the SCI-only group. Neuropsychological test performance was significantly worse in the SCI with TBI group, while the FIM cognition score did not discriminate because of ceiling effects. Greater evidence of psychopathology was observed in the SCI with TBI group.
The presence of TBI in SCI has a range of clinical and economic consequences. This dual diagnosis has the potential to affect SCI rehabilitation negatively, as well as quality of life and reintegration in the community. Specialized care appears to be needed to improve outcomes and to minimize clinical and economic burden, but further research is required.
评估创伤性脊髓损伤（SCI）患者中创伤性脑损伤（TBI）的临床和经济负担。
前瞻性病例匹配对照研究。
住院脊髓康复项目。
10例诊断为创伤性SCI并伴有TBI的患者与仅患有SCI的对照组进行匹配。
不适用。
住院康复住院时间、医疗费用（患者护理时长）、临床医生资源分配、行为和严重事件、FIM（功能独立性测量）、人格评估量表以及神经心理学评估结果。
与仅患有SCI的组相比，伴有TBI的SCI组出现意识丧失时间延长、康复费用增加以及对临床医生资源的需求更大（呈趋势）。伴有TBI的SCI组神经心理学测试表现明显更差，而由于天花板效应，FIM认知评分没有区分能力。在伴有TBI的SCI组中观察到更多精神病理学证据。
SCI中存在TBI会产生一系列临床和经济后果。这种双重诊断有可能对SCI康复、生活质量以及社区重新融入产生负面影响。似乎需要专门的护理来改善结果并最小化临床和经济负担，但还需要进一步研究。
