Adeline Hodgkinson

Late mortality after severe traumatic brain injury in New South Wales: a multicentre study

Objectives: To determine the long‐term mortality pattern of adults with severe traumatic brain injury (TBI), and to identify the risk factors associated with death in this group.

A multicentre, randomised trial examining the effect of test procedures measuring emergence from post-traumatic amnesia

Background: Post-traumatic amnesia (PTA) tests that record different PTA durations in the same patient, thereby raising measurement accuracy issues, have been reported previously. A major problem lies in determining the end point of PTA. Aims: To delineate areas of discrepancy in PTA tests and to provide independent verification for a criterion signalling emergence from PTA. Methods: In a randomised design, two related PTA procedures were compared, one purportedly more difficult (Westmead PTA Scale, WPTAS) than the other (Modified Oxford PTA Scale, MOPTAS). Eighty two patients in the early stages of PTA were examined daily until emergence, by using the Galveston Orientation and Amnesia Test (GOAT) and the WPTAS/MOPTAS. A short battery of cognitive and behavioural measurements was made on three occasions: at the early stage of PTA (time 1), towards the end of PTA when the maximum score (12/12) was first obtained (time 2) and at the traditional criterion for emergence (scoring 12/12 for 3 consecutive days; time 3). Results: No significant difference was recorded in PTA duration between the MOPTAS and WPTAS. Both scales recorded longer PTA durations than the GOAT. By using Kaplan–Meier survival analyses, the WPTAS was found to show a more protracted pattern of emergence at the end stage of PTA than the MOPTAS. A time lag of ⩾1 week in the resolution of disorientation as compared with amnesia was observed in 59% cases. Significant improvements occurred on all independent measurements between time 1 and time 2, but on only 2 of 5 cognitive measurements between time 2 and time 3. Conclusions: Although no significant differences in the duration of PTA on the MOPTAS/WPTAS were recorded, emergence from the late stages of PTA occurred more promptly with the MOPTAS. The need for inclusion of both orientation and memory items in PTA tests is highlighted by the frequency of disorientation–amnesia dissociations. The patterns of results on the independent measures suggest that patients who are in PTA for > 4 weeks have probably emerged from PTA when they first score 12/12 on the MOPTAS/WPTAS, and this criterion can replace the traditional criterion.

Social, neuroradiologic, medical, and neuropsychologic correlates of sexually aberrant behavior after traumatic brain injury: a controlled study.

Objective:To identify social, neuroradiological, medical, and neuropsychological correlates of sexually aberrant behavior (SAB) after traumatic brain injury (TBI). Design:A controlled study using a retrospective file review. Setting:A brain injury unit providing inpatient and outpatient rehabilitation services. Participants:A sample of males (n = 25) exhibiting SABs and a control group (n = 25) matched for gender, severity of injury, age at injury, and time after injury. Main Outcome Measures:A protocol that recorded data on demographic, injury, radiological, medical, and neuropsychological variables. Results:The SAB group had a significantly higher incidence of postinjury psychosocial disturbance in areas of nonsexual crime and failure to return to work than the matched TBI group. There were no significant differences between the two groups in the incidence of premorbid psychosocial disturbance or postinjury radiological, medical, or neuropsychological variables. Conclusions:The study results caution against simplistic explanations of SAB as the product of damage to the frontal-lobe systems or premorbid psychosocial disturbance. Furthermore, the results suggest that a wide-ranging assessment of people with TBI who exhibit SABs is required, because results of neuropsychological examination alone cannot be considered conclusive. Future research into the etiology of SABs could examine additional factors such as lack of insight, lack of empathy, and premorbid history of family dysfunction.

Comparing the injury profile, service use, outcomes, and comorbidities of people with severe TBI across urban, regional, and remote populations in New South Wales: a multicentre study

Objective:To compare the demographic/injury profile, outcomes, service utilization, and unmet service needs of individuals with severe traumatic brain injury across urban, regional, and remote areas of New South Wales. Setting:The 11 community-based rehabilitation teams of the New South Wales Brain Injury Rehabilitation Program. Participants:Active clients (N = 503) with severe traumatic brain injury. Design:A prospective cross-sectional multicenter study. Main Measures:Overt Behaviour Scale, Health of the Nation Outcome Scale-Acquired Brain Injury, Disability Rating Scale, Sydney Psychosocial Reintegration Scale-2, Care and Needs Scale, data protocol on service utilization, and unmet needs. Results:There were no differences in injury severity or functional outcomes across the 3 locations. However, clients in regional and remote areas had significantly higher levels of premorbid and postinjury comorbidities and lower levels of participation in comparison to urban clients. Although accessing the same number of services as their urban counterparts, clients in regional and remote areas had significantly higher levels of unmet needs suggesting problems with under-servicing. Conclusions:Geographical location had a significant impact on service access and outcomes.

A prospective interrupted time series study of interventions to improve the quality, rating, framing and structure of goal-setting in community-based brain injury rehabilitation

Objective: To investigate whether the introduction of an electronic goals system followed by staff training improved the quality, rating, framing and structure of goals written by a community-based brain injury rehabilitation team. Design: Interrupted time series design. Intervention: Two interventions were introduced six months apart. The first intervention comprised the introduction of an electronic goals system. The second intervention comprised a staff goal training workshop. Methods: An audit protocol was devised to evaluate the goals. A random selection of goal statements from the 12 months prior to the interventions (Time 1 baseline) were compared with all goal statements written after the introduction of the electronic goals system (Time 2) and staff training (Time 3). All goals were de-identified for client and time-period, and randomly ordered. Results: A total of 745 goals (Time 1 n = 242; Time 2 n = 283; Time 3 n = 220) were evaluated. Compared with baseline, the introduction of the electronic goals system alone significantly increased goal rating, framing and structure (χ2 tests 144.7, 18.9, 48.1, respectively, p < 0.001). The addition of staff training meant that the improvement in goal quality, which was only a trend at Time 2, was statistically significant at Time 3 (χ2 15.0, p ≤ 001). The training also led to a further significant increase in the framing and structuring of goals over the electronic goals system (χ2 11.5, 12.5, respectively, p ≤ 0.001). Conclusion: An electronic goals system combined with staff training improved the quality, rating, framing and structure of goal statements.