ABSTRACT
OBJECTIVE: To evaluate the performance of a limited set of three items from the Functional Independence Measure--eating, walking, and expression--(henceforth referred to as the Set) for use in acute trauma care and rehabilitation. DESIGN: Retrospective comparison of the Set-scores (3-item total) to the Functional Independence Measure (FIM) scores in 83 consecutive patients with a primary diagnosis related to trauma (90% of those eligible) over a 2-year period, on an acute rehabilitation unit in a tertiary care university hospital. METHODS: The age distributions of gender and diagnostic categories were examined. The sensitivity and specificity of the Set-score in detecting changes in the FIM were evaluated across a range of cut-off values. Correlation between FIM scores and Set-scores at admission, at discharge, and for interval change were assessed using the intraclass correlation coefficient. Sources of the Set's weaknesses were explored. RESULTS: Age distribution reflects the predisposition of older women to hip fractures and males to the other trauma. No degree of change in the Set-score provided a combination of sensitivity and specificity satisfactory for detecting potentially important changes in the FIM. Intraclass Correlation Coefficients (ICC) for Set-scores and FIM scores on admission and discharge were both .12. The ICC for the interval change data was .11. (95% confidence limits:--.11 to .34). CONCLUSION: This Set is not a useful measure of functional disability in a heterogeneous population of trauma patients.
Subject(s)
Activities of Daily Living , Wounds and Injuries/rehabilitation , Adolescent , Adult , Aged , Aged, 80 and over , Brain Injuries/rehabilitation , Brain Injuries/therapy , Child , Data Collection , Evaluation Studies as Topic , Female , Hip Fractures/rehabilitation , Hip Fractures/therapy , Humans , Male , Middle Aged , Retrospective Studies , Sex Factors , Spinal Cord Injuries/rehabilitation , Spinal Cord Injuries/therapy , Trauma Centers , Wounds and Injuries/therapyABSTRACT
We report a case of communicating hydrocephalus in a 24-year-old woman with previously undiagnosed systemic lupus erythematosus (SLE) presenting with malignant hypertension, nephritis, serositis, and a seizure disorder of 16 months' duration. The patient demonstrated features of the antiphospholipid antibody syndrome (APS). In proposing cerebral venous thrombosis as a possible, yet unproven, pathophysiologic mechanism for the hydrocephalus in this case we have reviewed and summarized literature relating to SLE, APS, hydrocephalus and pseudotumor cerebri. In cases of unexplained pseudotumor cerebri or hydrocephalus, a search for SLE and APS should be considered.
