ABSTRACT
Cognitive screening following mild traumatic brain injury (MTBI) remains variable with method of diagnosis, indications for testing, and utilization of results differing between institutions. The Neurobehavioral Cognitive Status Examination (NCSE) was originally developed for use in organic brain dysfunction and central nervous system (CNS) lesions. When attention is given to both the objective cognitive area scores and the "process features" component of the exam, it is an effective tool for identifying cognitive deficits associated with MTBI. One hundred seven MTBI patients underwent cognitive screening in the acute care setting. Memory was the function most frequently affected in patients with positive cognitive screens. Several of the NCSE deficits also correlated significantly with each other but not with memory. Age, length of stay, injury severity score (ISS), and cranial computed tomography scan were not associated with cognitive screen results. An admission Glasgow Coma Scale (GCS) of 13 or 14 was significantly associated with a positive cognitive screen, but a GCS of 15 did not predict a negative cognitive screen. All patients with MTBI require cognitive screening to identify deficits, ensure patient and family education, and when necessary facilitate treatment.
Subject(s)
Brain Injuries/psychology , Cognition/physiology , Wounds and Injuries/psychology , Adult , Female , Humans , Male , Neuropsychological Tests , Psychiatric Status Rating ScalesABSTRACT
A study of patients with mild traumatic brain injuries was performed to determine if cognitive screening in the acute care setting can identify patients who will have cognitive dysfunction following discharge to home. While still hospitalized, 166 patients were assessed with a cognitive screening tool. After discharge, telephone follow-up contacts were made by a nurse to assess for subjective reports of cognitive difficulties. A subsample (N = 39) received additional comprehensive cognitive evaluation after discharge. Statistically significant results were noted between cognitive screen and cognitive evaluation results (chi-square = 24.28, p < .0000) and between cognitive screen results and follow-up findings (chi-square = 6.7, p = .0350). Study results support the use of cognitive screening in the acute care setting to identify patients with mild traumatic brain injury who are likely to experience residual cognitive deficits after discharge so appropriate intervention may be planned.
Subject(s)
Brain Injuries/complications , Cognition Disorders/prevention & control , Inpatients , Mass Screening/methods , Neuropsychological Tests , Nursing Assessment , Adolescent , Adult , Aged , Aged, 80 and over , Chi-Square Distribution , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Cognition Disorders/nursing , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Discharge , Reproducibility of Results , Retrospective Studies , Sensitivity and SpecificityABSTRACT
One hundred forty-six trauma patients discharged from an acute care setting to home were followed during a 6-month period after discharge to determine functional problems they experienced and the time required to return to normal activity levels. At 1 week, 58% were unable to drive a care, 59% experienced difficulty with lifting, and 76% were unable to return to work. At 1 month, 27% continued to have trouble driving, 32% had trouble lifting, and 37% had not returned to work yet. Head injury patients and those with orthopedic injuries of the extremities or pelvis experienced problems returning to work. The head injury group also experienced vocational problems. By 6 months, 89% of the patients reported a return to normal activities. Findings suggest that a return to normal functioning level is a long-term process, and that certain injury types are at high risk for experiencing specific identifiable problems.
