Catherine F. Bontke

A model systems database for traumatic brain injury.

This article describes the development and characteristics of the database that supports the research and demonstration aspects of the traumatic brain injury (TBI) model systems project sponsored by the National Institute on Disability and Rehabilitation Research. Criteria for inclusion of patients

Medical complications and associated injuries of persons treated in the traumatic brain injury model systems programs

This study documents the medical complications and associated injuries that occurred in persons admitted for rehabilitation in the five Traumatic Brain Injury (TBI) Model System projects. The incidence of specific intracranial hemorrhages, medical complications, and associated injuries are discussed. Two thirds of these individuals had one or more intracranial hemorrhages, the most common being subdural (32%) and subarachnoid (27%) hemorrhages. Persons with one or two intracranial hemorrhages were found to have significantly longer lengths of stay (LOS) in acute care compared to those with no hemorrhahges. One or more intracranial hemorrhages were found in persons injured by a fall (84%), while riding a bicycle (81%), while walking (76%), and by assault (73%). Of the nonhemorrhagic cerebral complications/problems investigated, seizures, cerebrospinal fluid (CSF) leak, and hydrocephalus were found to be related to extended LOS in acute care. Seizures were reported in 17% of patients, with 10% of all patients exhibiting a seizure within the first 24 hours postinjury. The extracerebral complications associated with longer LOS in acute care were respiratory failure, pneumonia, urinary tract infection, soft-tissue infection (STI), coagulopathy, renal failure, and septic shock. Persons injured in all-terrain vehicles, pedestrian/auto encounters, gunshot wounds to the head, and automobile crashes were more likely to have extracerebral complications than those injured by other causes. Fractures and cranial nerve injuries were the most common associated injuries. A larger proportion of persons injured in motor vehicle crashes, pedestrian/auto encounters, and bicycle accidents had associated injuries than those injured by other mechanisms.

Managed Care in Traumatic Brain Injury Rehabilitation: Physiatristsʼ Concerns and Ethical Dilemmas

Tills article deals with concerns and ethical dilemmas of physiatrists who specialize in brain Injury rehabilitation in a managed care environment. Challenged to provide daily cost-effective care in a quality manner, physiatrists have become Increasingly concerned with their clinical decision-making autonomy and with perceptions of changing standards in clinical care. This article explores these concerns and raises potential solutions that may help manage them.

Impact of traumatic brain injury on pregnancy

A significant number of women are at risk to sustain traumatic brain injury during their childbearing years. In this article, the authors present four case studies and a review of literature pertinent to medical and social management of such a patient in the rehabilitation setting.