Greiss Christine, Yonclas Peter P, Jasey Neil, Lequerica Anthony, Ward Irene, Chiaravalloti Nancy, Felix Gabriel, Dabaghian Laurie, Livingston David H
From the Departments of Physical Medicine and Rehabilitation (C.G., L.D.), and Surgery (P.P.Y., D.H.L.), Rutgers-New Jersey Medical School, Newark; and Department of Physical Medicine and Rehabilitation (C.G.), Kessler Institute for Rehabilitation (N.J., A.L., I.W., N.C., G.F.), West Orange, New Jersey.
J Trauma Acute Care Surg. 2016 Jan;80(1):70-5. doi: 10.1097/TA.0000000000000890.
Maximizing long-term recovery following traumatic brain injury (TBI) is an important end point. We hypothesized that the addition of a dedicated physiatrist specializing in brain injury medicine to the trauma team would lead to improved functional outcomes.
Data from the Northern NJ TBI Model Systems were queried for all patients admitted to rehabilitation from four regional trauma centers, one with a full-time TBI physiatrist (PHYS) and three without (NO-PHYS). Patient demographics, mechanism of injury, Glasgow Coma Scale (GCS) score, length of posttraumatic amnesia, length of stay, and Functional Independence Measure (FIM) were abstracted. TBI severity was determined by GCS score and length of posttraumatic amnesia. FIM motor and cognitive scores at rehabilitation admission and discharge were the primary outcome measure. TBI medications (stimulants, sleep, and neurodepressants) administered in acute care were reviewed to evaluate prescription patterns.
A total of 148 patients treated at four trauma centers and discharged to a single acute inpatient rehabilitation center between 2005 to 2013 were divided into two groups, PHYS with 44 patients and NO-PHYS with 104 patients. Compared with those in the NO-PHYS group, patients from the PHYS group had significant improvement in FIM motor and cognitive scores (p < 0.05). Prescription patterns differed. Patients from the PHYS group received significantly more neurostimulants (p < 0.001) and sleep medications (p = 0.02) compared with the NO-PHYS group. Analysis of covariance was conducted to examine FIM (motor and cognitive) changes from rehabilitation admission to discharge based on medications initiated in acute care. Those who received neither a neurostimulant nor a sleep medication had significantly lower FIM motor scores compared with those who received at least one of these medications (p = 0.047) and compared with those who received both types of medication (p = 0.17). No significant differences were found in FIM cognitive scores.
The addition of a dedicated physiatrist providing early specialized care to patients who sustained a moderate or severe TBI was associated with improved functional outcomes upon discharge from rehabilitation. The presence of a dedicated trauma center physiatrist, trained in TBI rehabilitation, was also associated with a change in neuroprotective medication management in the acute care setting.
Therapeutic study, level IV.
使创伤性脑损伤（TBI）后的长期恢复最大化是一个重要的终点。我们假设在创伤团队中增加一名专门从事脑损伤医学的物理治疗师会带来更好的功能结局。
查询新泽西州北部TBI模型系统中所有从四个地区创伤中心收治到康复机构的患者数据，其中一个中心有一名全职TBI物理治疗师（PHYS组），另外三个中心没有（NO-PHYS组）。提取患者的人口统计学信息、损伤机制、格拉斯哥昏迷量表（GCS）评分、创伤后遗忘时长、住院时长和功能独立性测量（FIM）。TBI严重程度由GCS评分和创伤后遗忘时长确定。康复入院和出院时的FIM运动和认知评分是主要结局指标。回顾急性护理中使用的TBI药物（兴奋剂、睡眠药物和神经抑制剂）以评估处方模式。
2005年至2013年间在四个创伤中心接受治疗并转入单一急性住院康复中心的148例患者被分为两组，PHYS组44例患者，NO-PHYS组104例患者。与NO-PHYS组相比，PHYS组患者的FIM运动和认知评分有显著改善（p<0.05）。处方模式不同。与NO-PHYS组相比，PHYS组患者接受的神经兴奋剂（p<0.001）和睡眠药物（p=0.02）明显更多。进行协方差分析以检查基于急性护理中开始使用的药物，从康复入院到出院时FIM（运动和认知）的变化。与至少接受其中一种药物的患者相比，既未接受神经兴奋剂也未接受睡眠药物的患者FIM运动评分显著更低（p=0.047），与接受两种药物的患者相比（p=0.17）。FIM认知评分未发现显著差异。
为中度或重度TBI患者提供早期专科护理的专职物理治疗师的加入与康复出院时更好的功能结局相关。在TBI康复方面接受过培训的专职创伤中心物理治疗师的存在也与急性护理环境中神经保护药物管理的变化相关。
治疗性研究，IV级。
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