Inconsistencies with screening for traumatic brain injury in spinal cord injury across the continuum of care

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1357105 · Published: January 1, 2019

Spinal Cord Injury Rehabilitation Brain Injury

Simple Explanation

This study investigates how consistently traumatic brain injury (TBI) is identified in patients who also have a spinal cord injury (SCI) as they move through different stages of medical care. The research found that there is significant inconsistency in how TBI is screened and documented for SCI patients across emergency departments, acute care hospitals, and rehabilitation facilities. The findings suggest a need for standardized screening processes and better communication between healthcare providers to ensure that TBI is accurately identified and treated in SCI patients.

Study Duration

3 Years

Participants

49 subjects with traumatic SCI

Evidence Level

Level 3: Retrospective chart review

Key Findings

1
TBI occurred in 65% of SCI individuals, but documentation of identification of TBI, LOC, and CT imaging results varied across the continuum of care.
2
GCS was recorded for all patients based on EMS and/or ED documentation, while PTA was only ever documented in the trauma psychology notes.
3
Patients without TBI had significantly higher Motor FIM, Cognitive FIM, and total FIM scores upon admission and discharge compared to those with TBI.

Research Summary

This study aimed to explore how TBI is screened among SCI patients across the continuum of care, using a retrospective chart review of 49 patients with traumatic SCI. The results revealed that TBI occurred in 65% of SCI individuals, but documentation of identification of TBI, LOC, and CT imaging results varied across the continuum. The study concludes that there is a need to standardize screening processes between acute care and inpatient rehabilitation facilities to improve the identification and treatment of dual diagnosis.

Practical Implications

Standardized Screening

Implement mandated TBI screening questions and documentation within electronic records across settings to ensure consistent identification.

Improved Communication

Enhance communication between healthcare providers across the continuum of care to accurately convey TBI diagnoses and related findings.

Dual Diagnosis Tracks

Establish dual diagnosis tracks within inpatient rehabilitation systems to provide specialized care for SCI patients with concurrent TBI.

Study Limitations

1
Documentation practices varied across the continuum.
2
There was no singular place for quality metrics to identify TBI because of inconsistent documentation templates and practices.
3
Data collection was restricted to history and physicals, and discharge summaries, potentially missing TBI identification in clinician daily notes.

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