The assessment of consciousness following a traumatic brain injury among veterans and non-veterans

摘要

A study of the validity of a new assessment tool---DOCS---and the usefulness of neurological indicators for predicting functional outcome 6 months after a severe TBI was carried out. A cross-sectional approach with longitudinal aspects was employed. A subject was included if they had incurred a severe TBI and had an initial GCS score of 8 or less. If the medical record did not supply adequate information regarding when and how the initial GCS was calculated, then a written survey regarding the attending physician's usual and routine methods for computing the GCS was completed. Thirteen persons that incurred a severe TBI were evaluated with the DOCS. There were a total of 20 administrations of the DOCS and the GCS with these 13 subjects. Inter-rater reliability data, validity information and information regarding neurological indicators were gathered through these evaluations. Each patient's primary care giver participated in a 6-month follow-up interview over the phone. The FIM, the SF-36 and the CIQ were used to gather functional outcome information during the follow-up interviews.;The results indicated that the DOCS was moderately associated with the GCS. Poorly fitting DOCS test items were identified and the DOCS was restructured to improve its measuring capability. The visual sub-scale of the DOCS was found to function independently of the other DOCS sub-scales. The restructured DOCS and the restructured arousal scale of the DOCS showed promise for future application in predicting outcome. Veterans that had incurred a severe TBI were admitted earlier to in-patient rehabilitation relative to non-veterans and they also had longer lengths of stay once admitted. The veterans also had better outcome scores than the non-veterans.;The results from this study provide the basis for future research regarding validation of behavioral evaluation methodologies and their use in predicting functional outcome. These results also provide the basis for further refinement of the definitions proposed in the Aspen Neurobehavioral Consensus Statement.