scholarly journals ACUTE PERFORMANCE ON A VESTIBULAR AND OCULAR MOTOR SCREENER AND RECOVERY FOLLOWING CONCUSSION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0013
Author(s):  
Scott O. Burkhart ◽  
Christine Ellis ◽  
Troy M. Smurawa
Keyword(s):  
Psychiatric Diagnosis ◽  
Descriptive Statistics ◽  
Acute Injury ◽  
Ocular Motor ◽  
Motor Impairments ◽  
Certified Athletic Trainers ◽  
Symptom Provocation ◽  
History Of ◽  
Recovery Group ◽  
Recovery Groups

Background: Concussion injuries are synonymous with vestibular impairments and symptoms include dizziness, impaired balance, and problems with gaze stability (Covassin et al., 2014). Common ocular motor impairments after a concussion include convergence/accommodative insufficiencies and saccadic dysfunction (Mucha et al., 2014). Vestibular and ocular motor impairments have been linked to worse outcomes following concussion (Pearce et al., 2015), including prolonged recovery (Corwin et al., 2015). The purpose of the current study was to determine which VOMS impairments were linked with longer recovery. Methods: Pediatric patients diagnosed with concussion (n = 131) presenting to an outpatient concussion clinic within 7 days from their initial date of injury were administered a standardized version of the VOMS. Patients were administered the VOMS by certified athletic trainers educated and trained on administration. The VOMS consists of nine measures and was validated by the University of Pittsburgh (Mucha et al., 2014) as a symptom provocation measure with a symptom rating of 0-10 with convergence measured in centimeters, and scores of 6 cm or greater being indicative of abnormal. Demographic, acute injury, and baseline values were summarized using descriptive statistics. Point estimates and 95% confidence intervals were calculated for all end points. Results: 131 patients with a mean age of 13.5 + 2.4 completed the VOMS within 7 days (mean = 3.2 + 1.7) of a diagnosed concussion. The sample was evenly divided by gender (52.7% male, 47.3% female). Patients were grouped by recovery time: <14 days (n = 19, 14.5%) 15-28 days (n = 64, 48.9%), and 29-120 days (n = 48, 36.6%). In the <14 day recovery group, 5.2% (n = 2) reported a history of concussion, 15.8% (n = 3) reported a history of migraine, and 5.2% (n = 2) reported a history of psychiatric diagnosis. In the 15-28 day recovery group, 21.9% (n = 14) reported a history of concussion, 9.4% (n = 6) reported a history of migraine, and 6.5% (n = 4) reported a history of psychiatric diagnosis. In the 29-120 day recovery group, 25% (n = 12) reported a history of concussion, 25% (n = 12) reported a history of migraine, and 6.25% (n = 3) reported a history of psychiatric diagnosis. Descriptive statistics for baseline VOMS symptoms were recorded for the <14 day recovery group; headache (mean = 1 + 1.49, CI = 0.7 -1.3), dizziness (mean = 0.2 + 0.5, CI = 0.1-0.3), nausea (mean = 0 + 0, CI = 0-0), and fogginess (mean = 0.9 + 1.5, CI = 0.5 -1.3), for the 15-28 day recovery group; headache (mean = 3.3 + 2.4, CI = 3-3.6), dizziness (mean = 1.5 + 1.9, CI = 1.3 -1.7), nausea (mean = 0.8 + 1.7, CI = 0.6 -1), and fogginess (mean = 1.7 + 2.2, CI = 1.4-2), for the 29-120 day recovery group; headache (mean = 4.4 + 2.2, CI = 4.1-4.7), dizziness (mean = 1.9 + 2.2, CI = 1.6-2.2), nausea (mean = 1.4 + 2.2, CI = 1.1 -1.7), and fogginess (mean = 2.4 + 2.9, CI = 2-2.8). VOMS convergence in centimeters across trials for the <14 day recovery group; T1 (mean = 2.6 + 2.4, CI = 2.1-3.1), T2 (mean = 3.4 + 2.4, CI = 2.9-3.9), and T3 (mean = 3.8 + 2.5, CI = 3.2-4.4), for the 15-29 day recovery group; T1 (mean = 3.9 + 3.9, CI = 3.4-4.4), T2 (mean = 4.8 + 4.2, CI = 4.3-5.3), and T3 (mean = 5.3 + 5.1, CI = 4.7-5.9), for the 29-120 day recovery group; T1 (mean = 6.9 + 5.2, CI = 6.1-7.7), T2 (mean = 8.3 + 1.8, CI = 7.4-9.2), and T3 (mean = 9.6 + 2.1, CI = 8.6-10.6). VOMS symptom provocation increase of +2 and +3 from baseline were totaled for each recovery group. Abnormal convergence greater than 6 cm on any trial was totaled for each group. Percentages for all 3 recovery groups with symptom provocation of +2, +3, and abnormal convergence were calculated. In the <14 day recovery group, 21% had a +2 symptom provocation on at least one symptom, 16% had a +3 symptom increase on at least one symptom, and 16% had abnormal convergence greater than 6 cm on at least one convergence trial. 11% of the <14 day recovery group had a +2, +3, increase and abnormal convergence greater than 6 cm. In the 15-29 day recovery group, 69% had a +2 symptom provocation on at least one symptom, 34% had a +3 symptom increase on at least one symptom, and 38% had abnormal convergence greater than 6 cm on at least one convergence trial. 13% of the 15-29 day recovery group had a +2, +3, increase and abnormal convergence greater than 6 cm. In the 29-120 day recovery group, 85% had a +2 symptom provocation on at least one symptom, 60% had a +3 symptom increase on at least one symptom, and 58% had abnormal convergence greater than 6 cm on at least one convergence trial. 38% of the 29-120 day recovery group had a +2, +3, increase and abnormal convergence greater than 6 cm. Conclusion: The current study identified symptom provocation of +2 and +3 as well as abnormal convergence greater than 6 cm were the most synonymous with recovery across the three recovery groups. Clinicians should consider these findings in providing recommendations and discussing anticipated recovery with patients. Further research is needed to determine more definitive parameters when predicting recovery following concussion.

scholarly journals VESTIBULAR AND OCULAR MOTOR FINDINGS IN ACUTELY INJURED 8-12-YEAR-OLD PATIENTS FOLLOWING CONCUSSION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0000
Author(s):  
Scott O. Burkhart ◽  
Christine Ellis ◽  
Troy M. Smurawa
Keyword(s):  
Motor Performance ◽  
Pediatric Patients ◽  
Performance Measure ◽  
Descriptive Statistics ◽  
Acute Injury ◽  
Ocular Motor ◽  
Motor Assessment ◽  
Old Patients ◽  
History Of ◽  
Pearson Correlations

Background: Vestibular and ocular motor deficits have been recognized as a key marker of the pathophysiology consistent with the diagnosis of concussion (Grady, 2010). Previous studies have been performed detailing the validity and clinical benefit of vestibular and ocular motor assessments (Corwin et al., 2015; Mucha et al., 2014). Recent guidelines and position statements have started recommending the use of vestibular and ocular motor assessment for pediatric patients (Matuszak et al., 2016), the most recent consensus statement recommending vestibular and ocular motor assessment by all practitioners within acute concussion settings (McCrory et al., 2017). Unfortunately, very little data exists with respect to vestibular and ocular motor performance in concussion patients between 8-12 years of age. The current study included a standardized administration of the Vestibular Ocular Motor Screening (VOMS) and the King-Devick Test (KD) in a sample of patients diagnosed with concussion and evaluated in an outpatient concussion clinic within 7 days of their initial date of injury. This study intended to evaluate performance on the VOMS and KD in an injured sample of patients 8-12 years of age. Methods: Pediatric patients diagnosed with concussion (n = 45) presenting to an outpatient concussion clinic within 7 days from their initial date of injury were administered a standardized version of the VOMS and KD. Patients were administered the VOMS and KD by certified athletic trainers educated and trained on administration. The VOMS consists of nine measures and was validated by the University of Pittsburgh (Mucha et al., 2014) as a symptom provocation measure with a symptom rating of 0-10 with convergence measured in centimeters, and scores of 6 cm or greater being indicative of abnormal. The KD is an ocular motor performance measure and has previously demonstrated reliability, sensitivity and specificity with respect to concussion diagnosis (Hecimovich et al., 2018). Demographic, acute injury, and baseline values were summarized using descriptive statistics. Point estimates and 95% confidence intervals were calculated for all end points. Pearson correlations were calculated based numerical values from the VOMS and KD data. Results: The total sample consisted of 14 females and 31 males, with a mean age of 10.6 + 1.4 years. 20% of the subjects (n = 9) reported a prior history of concussion with a total of 17 previous concussions reported. 13.3% of the sample (n = 6) reported a history of migraine and 4.4% (n = 2) reported a history of psychiatric diagnosis. Acute self-reported injury data based on signs and symptom markers were calculated including; dizziness (66.6%, n = 30), headache (82.2%, n = 37), vision problems (42.2%, n = 19), amnesia (35.5%, n = 16), and loss of consciousness (22.2%, n = 10). Descriptive statistics for baseline VOMS symptoms were recorded; headache (mean = 3.2 + 2.7, CI = 2.8-3.6), dizziness (mean = 1.3 + 1.7, CI = 1.1 -1.5) nausea (mean = 0.7 + 1.6, CI = 0.5-0.9), and fogginess (mean = 1.1 + 2.0, CI = 0.8 -1.4). VOMS convergence in centimeters across trials; T1 (mean = 5.1 + 5.2, CI = 4.6-5.9), T2 (mean = 6.2 + 5.8, CI = 5.3-7.1), and T3 (mean = 7.1 + 6.9, CI = 6.1-8.1). KD time in seconds; card 1 (mean = 22.4 + 9.5, CI = 21-23.8), card 2 (mean = 23.1 + 9.5, CI = 21.7-24.5), card 3 (mean = 27.2 + 9.3, CI = 25.8-28.6), and total (mean = 72.8 + 27.3, CI = 68.7-76.9). Pearson correlations revealed strong correlations across VOMS symptoms; headache (r = 0.89-0.99), dizziness (r = 0.78-0.98), nausea (r = 0.88-0.98), and fogginess (r = 0.89-0.98). Moderate correlations between KD time and convergence distance were observed; KD card 1 (convergence T1, r = 0.61, convergence T2, r = 0.58, convergence T3, r = 0.49), KD card 2 (convergence T1, r = 0.62, convergence T2, r = 0.58, convergence T3, r = 0.48), and KD total time (convergence T1, r = 0.59, convergence T2, r = 0.54, convergence T3, r = 0.46). Conclusion: To the best knowledge of the authors involved, this study is the first of its kind to explore the performance on the VOMS and KD in a sample of acutely injured (< 7 days) 8-12-year-old patients diagnosed with concussion. Several notable findings were observed. Headache was the most predominant symptom reported during VOMS administration and remained significantly higher than the other symptoms of dizziness, nausea, and fogginess. This finding may be the byproduct of increased difficulty in symptom description between the ages of 8-12. Further, correlations within symptoms were strong suggesting throughout VOMS administration symptoms remain relatively stable. Lastly, moderate relationships were noted between convergence on the VOMS and KD time scores. This is likely a result of both measures addressing ocular motor functioning but differing based on data medium (centimeters versus seconds). The current study was limited based on sample size and further data is necessary to draw larger conclusions based on 8-12-year-old injured VOMS and KD performance.

A Positive Vestibular/Ocular Motor Screening (VOMS) Is Associated With Increased Recovery Time After Sports-Related Concussion in Youth and Adolescent Athletes

2016 ◽  
Vol 45 (2) ◽  
pp. 474-479 ◽  
Author(s):  
Anthony J. Anzalone ◽  
Damond Blueitt ◽  
Tami Case ◽  
Tiffany McGuffin ◽  
Kalyssa Pollard ◽  
...  
Keyword(s):  
Recovery Time ◽  
Retrospective Chart Review ◽  
Hazard Ratio ◽  
Return To Play ◽  
Diagnostic Tools ◽  
Ocular Motor ◽  
Motor Impairments ◽  
Level Of Evidence ◽  
Symptom Provocation ◽  
Clinical Abnormality

Background: Vestibular and ocular motor impairments are routinely reported in patients with sports-related concussion (SRC) and may result in delayed return to play (RTP). The Vestibular/Ocular Motor Screening (VOMS) assessment has been shown to be consistent and sensitive in identifying concussion when used as part of a comprehensive examination. To what extent these impairments or symptoms are associated with length of recovery is unknown. Purpose: To examine whether symptom provocation or clinical abnormality in specific domains of the VOMS results in protracted recovery (time from SRC to commencement of RTP protocol). Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A retrospective chart review was conducted of 167 patients (69 girls, 98 boys; mean ± SD age, 15 ± 2 years [range, 11-19 years]) presenting with SRC in 2014. During the initial visit, VOMS was performed in which symptom provocation or clinical abnormality (eg, unsmooth eye movements) was documented by use of a dichotomous scale (0 = not present, 1 = present). The VOMS used in this clinic consisted of smooth pursuits (SMO_PUR), horizontal and vertical saccades (HOR_SAC and VER_SAC), horizontal and vertical vestibular ocular reflex (HOR_VOR and VER_VOR), near point of convergence (NPC), and accommodation (ACCOM). Domains were also categorized into ocular motor (SMO_PUR, HOR_SAC, VER_SAC, NPC, ACCOM) and vestibular (HOR_VOR, VER_VOR). Cox proportional hazard models were used to explore the relationship between the domains and recovery. Alpha was set at P ≤ .05. Results: Symptom provocation and/or clinical abnormality in all domains except NPC ( P = .107) and ACCOM ( P = .234) delayed recovery (domain, hazard ratio [95% CI]: SMO_PUR, 0.65 [0.47-0.90], P = .009; HOR_SAC, 0.68 [0.50-0.94], P = .018; VER_SAC, 0.55 [0.40-0.75], P < .001; HOR_VOR, 0.68 [0.49-0.94], P = .018; VER_VOR, 0.60 [0.44-0.83], P = .002). The lowest crude hazard ratio was for ocular motor category (0.45 [0.32-0.63], P < .001). Conclusion: These data suggest that symptom provocation/clinical abnormality associated with all domains except NPC and ACCOM can delay recovery after SRC in youth and adolescents. Thus, the VOMS not only may augment current diagnostic tools but also may serve as a predictor of recovery time in patients with SRC. The findings of this study may lead to more effective prognosis of concussion in youth and adolescents.

scholarly journals Recovery of new-onset kidney disease in COVID-19 patients discharged from hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nan-Hui Zhang ◽  
Yi-Chun Cheng ◽  
Ran Luo ◽  
Chun-Xiu Zhang ◽  
Shu-Wang Ge ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Kidney Diseases ◽  
Descriptive Statistics ◽  
Limited Information ◽  
High Discharge ◽  
Discharged Patients ◽  
Recovery Group ◽  
Abundant Data ◽  
New Onset

Abstract Background Coronavirus disease 2019 (COVID-19) has emerged as a major global health threat with a great number of deaths worldwide. Despite abundant data on that many COVID-19 patients also displayed kidney disease, there is limited information available about the recovery of kidney disease after discharge. Methods Retrospective and prospective cohort study to patients with new-onset kidney disease during the COVID-19 hospitalization, admitted between January 28 to February 26, 2020. The median follow-up was 4 months after discharge. The follow-up patients were divided into the recovery group and non-recovery group. Descriptive statistics and between-groups comparison were used. Results In total, 143 discharged patients with new-onset kidney disease during the COVID-19 hospitalization were included. Patients had a median age was 64 (IQR, 51–70) years, and 59.4% of patients were men. During 4-months median follow-up, 91% (130 of 143) patients recovered from kidney disease, and 9% (13 of 143) patients haven’t recovered. The median age of patients in the non-recovery group was 72 years, which was significantly higher than the median age of 62 years in the recovery group. Discharge serum creatinine was significantly higher in the non-recovery group than in the recovery group. Conclusions Most of the new-onset kidney diseases during hospitalization of COVID-19 patients recovered 4 months after discharge. We recommend that COVID-19 patients with new-onset kidney disease be followed after discharge to assess kidney recovery, especially elderly patients or patients with high discharge creatinine.

scholarly journals Identifying Attitudes and Deterring Factors Toward Continuing Education Among Certified Athletic Trainers

2005 ◽  
Author(s):  
Brian Hughes
Keyword(s):  
Continuing Education ◽  
Positive Attitude ◽  
Athletic Trainers ◽  
Descriptive Statistics ◽  
State University ◽  
Certified Athletic Trainers ◽  
Demographic Groups ◽  
Indiana State University ◽  
On Line ◽  
And Cluster Analysis

Objective: To explore the perceived attitudes toward continuing education and the deterrents to continuing education for certified athletic trainers (ATCs). Design and Setting: Data were collected using the Adults Attitudes Towards Continuing Education Scale (AATCES) instrument, Deterrents to Participation Scale-General (DPS-G) instrument, and self-reported demographics. Subjects: An imbedded on-line questionnaire was e-mailed three times in a 6-week period to ATCs who subscribe to the athletic trainers listserv at Indiana State University and the professional athletic trainers education listserv at Findlay University. The sample of this study consisted of approximately 1,200 ATCs of which 268 answered and returned the survey, a return rate of 22%. Measurements: Data included descriptive statistics, a one-way Analysis of Variance (ANOVA), and Cluster Analysis to compare the demographic groups on the AATCES and the DPS-G instruments. Results: This study found that the participants have a very positive attitude toward continuing education according to the AATCES instrument and that the participants report few deterrents through the DPS-G instrument. However, two deterrents of statistical importance were found in the items related to Time and Course Relevance and one deterrent, Cost, was found in the comparison to gender.Conclusions: This study found that ATCs have a very favorable attitude toward continuing education and that ATCs perceive few deterrents to continuing education. To further understand these trends in continuing education, these particular surveys must be made available to more ATCs. In addition, continuing education providers need to understand the needs of the ATCs that they serve.

scholarly journals Ergonomic Design of Classroom Furnitures: Evaluation of Comfortability and Musculoskeletal Disorders

2021 ◽  
Author(s):  
Kojo Agyapong Afrifah ◽  
Mark Glalah
Keyword(s):  
Musculoskeletal Disorders ◽  
Previous History ◽  
Descriptive Statistics ◽  
Furniture Design ◽  
Kwame Nkrumah ◽  
Lower Back ◽  
High Incidence ◽  
History Of ◽  
Spss Software ◽  
Wooden Furniture

Background: Anthropometric studies are essential in furniture design to ensure comfortability and improved productivity of the users. Methods: Anthropometry of 407 from a population of 5601 students, and classroom furniture at Kwame Nkrumah University of Science and Technology were evaluated. Student’s comfortability and reported musculoskeletal disorders (MSDs) in using the furniture were assessed with two questionnaires. Participants who volunteered for the study were randomly selected and had no previous history of MSDs. Descriptive statistics of the collected data were analyzed using SPSS software. Results: The participant's aged ranged from 17 to 28 years, and mostly were female (61%). The fitness between student’s anthropometry and classroom furniture included underneath table height for the imported plastic furniture and chair seat depth and width, as well as underneath table height for the locally manufactured wooden furniture. We observed high incidence of MSDs, including upper back (71.40%), lower back (58.30%), neck (51.90%), joint (39.10%), shoulder (32%), knee (25.20%), and wrist (22.60%) pain. The prevalence of MSDs were higher in women than men. The majority of the students were uncomfortable with using the furnitures, and only 6.6% reported comfortable experience. Conclusion: Recommended dimensions for ergonomically designed furniture have been proposed to reduce MSDs in the students. It would improves student’s health, and promote comfortability.

Appropriate Use of Recovery Groups in Nonclinical Toxicity Studies: Value in a Science-Driven Case-by-Case Approach

2011 ◽  
Vol 49 (2) ◽  
pp. 357-361 ◽  
Author(s):  
K. Pandher ◽  
M. W. Leach ◽  
L. A. Burns-Naas
Keyword(s):  
Laboratory Animal ◽  
Prolonged Exposure ◽  
Recovery Phase ◽  
Regulatory Requirements ◽  
Appropriate Use ◽  
Toxicity Studies ◽  
Animal Use ◽  
Antidrug Antibodies ◽  
Recovery Group ◽  
Recovery Groups

A recovery phase—a nondosing period that follows the main dosing phase of a study—is sometimes included in nonclinical toxicity studies, and it is designed to understand whether toxicities observed at the end of the dosing phase are partially or completely reversible. For biopharmaceuticals with long half-lives, the inclusion of recovery arms can be helpful in understanding effects of prolonged exposure and assessing antidrug antibodies. This commentary discusses when to include recovery groups in nonclinical toxicity studies, the number of recovery groups to include in a given study, the number of animals to include in each recovery group, and the duration of the recovery phase. In general, the inclusion of recovery arms should follow a case-by-case approach that values rational scientific design and reflects the development needs and regulatory requirements applicable to individual nonclinical programs to ensure appropriate guidance for human studies while minimizing laboratory animal use.

scholarly journals Ocular neuromyotonia

2018 ◽  
Vol 18 (5) ◽  
pp. 389-390 ◽  
Author(s):  
Ricardo Soares-dos-Reis ◽  
Ana Inês Martins ◽  
Ana Brás ◽  
Anabela Matos ◽  
Conceição Bento ◽  
...  
Keyword(s):  
Motor Nerve ◽  
Underlying Mechanism ◽  
Motor Disorder ◽  
Ocular Motor ◽  
Drug Switching ◽  
Ephaptic Transmission ◽  
History Of ◽  
The Brain ◽  
Ocular Neuromyotonia ◽  
Fourth Nerve Palsy

Ocular neuromyotonia is a rare, albeit treatable, ocular motor disorder, characterised by recurrent brief episodes of diplopia due to tonic extraocular muscle contraction. Ephaptic transmission in a chronically damaged ocular motor nerve is the possible underlying mechanism. It usually improves with carbamazepine. A 53-year-old woman presented with a 4-month history of recurrent episodes of binocular vertical diplopia (up to 40/day), either spontaneously or after sustained downward gaze. Between episodes she had a mild left fourth nerve palsy. Sustained downward gaze consistently triggered downward left eye tonic deviation, lasting around 1 min. MR scan of the brain was normal. She improved on starting carbamazepine but developed a rash that necessitated stopping the drug. Switching to lacosamide controlled her symptoms.

scholarly journals Stroke impairment categories: A new way to classify the effects of stroke based on stroke-related impairments

2020 ◽  
pp. 026921552096647
Author(s):  
Matthew Gittins ◽  
David Lugo-Palacios ◽  
Andy Vail ◽  
Audrey Bowen ◽  
Lizz Paley ◽  
...  
Keyword(s):  
Classification System ◽  
Expert Knowledge ◽  
Descriptive Statistics ◽  
Stroke Severity ◽  
National Audit ◽  
Motor Impairments ◽  
Sensory Impairments ◽  
Scale Scores ◽  
Data Source ◽  
To Receive

Objective: To create a classification system based on stroke-related impairments. Data source: All adults with stroke admitted for at least 72 hours in England, Wales and Northern Ireland from July 2013 to July 2015 extracted from the Sentinel Stroke National Audit Programme Analysis: Impairments were defined using the National Institute of Health Stroke Scale scores at admission. Common combinations of impairments were identified based on geometric coding and expert knowledge. Validity of the classification was assessed using standard descriptive statistics to report and compare patients’ characteristics, therapy received and outcomes in each group. Results: Data from 94,905 patients were extracted. The items of the National Institute of Health Stroke Scale (on admission) were initially grouped into four body systems: Cognitive, Motor, Sensory and Consciousness. Seven common combinations of these impairments were identified (in order of stroke severity); Patients with Loss of Consciousness ( n = 6034, 6.4%); those with Motor + Cognitive + Sensory impairments ( n = 28,226, 29.7%); Motor + Cognitive impairments ( n = 16,967, 17.9%); Motor + Sensory impairments ( n = 9882, 10.4%); Motor Only impairments ( n = 20,471, 21.6%); Any Non-Motor impairments ( n = 7498, 7.9%); and No Impairments ( n = 5827, 6.1%). There was a gradation of age, premorbid disability, mortality and disability on discharge. People with the most and least severe categories were least likely to receive therapy, and received least therapy (−20 minutes/day of stay) compared to −35 minutes/day of stay for the moderately severe categories. Conclusions: A classification system of seven Stroke Impairment Categories has been presented.

scholarly journals SENSITIVITY OF SELF-REPORTED COMORBIDITIES COMPARED TO MEDICARE CLAIMS IN OLDER ADULTS WITH TRAUMATIC BRAIN INJURY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S483-S483
Author(s):  
Aparna Vadlamani ◽  
Jennifer Albrecht
Keyword(s):  
Older Adults ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Medical History ◽  
Acute Injury ◽  
Administrative Claims ◽  
Comorbid Illness ◽  
Medicare Claims ◽  
Patient Reported ◽  
History Of

Abstract Patient reported history of comorbid illness may be the only information available to the treatment team during an acute injury admission. Nevertheless, acute injury, particularly traumatic brain injury (TBI) which affects cognition, may decrease the patient’s ability to accurately report medical history. Thus, the objective of this study was to evaluate the accuracy of patient-reported comorbid illness burden compared to the patient’s Medicare administrative claims. Records of older adults treated for TBI at an urban level 1 trauma center 2006-2010 were linked to their Medicare administrative. Comorbidities were recorded in Medicare claims based on ICD9 codes and were reported in the trauma registry (TR) based on patient medical history recorded by a physician or nurse. Prevalence of each of the following comorbidities was calculated using information from the TR and claims: Alzheimer’s disease and related dementias, chronic kidney disease, COPD, heart failure, diabetes, depression, stroke, and hypertension. Sensitivity of each patient-reported comorbidity was calculated using Medicare claims as the gold standard. We identified patient factors associated with accurate self-report using logistic regression. Among 408 older adults with TBI that linked to their Medicare claims, prevalence of each comorbidity was higher in Medicare claims compared to the TR, except for hypertension. Sensitivity for detecting these comorbidities using the TR ranged from 2% to 68%, with the highest sensitivity observed for hypertension. Older age and race were predictors of less accurate reported medical history. Reconciling self-reported patient history of these comorbidities with those reported in claims can better inform decisions regarding treatment.

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