Medical complications and associated injuries of persons treated in the traumatic brain injury model systems programs

This study documents the medical complications and associated injuries that occurred in persons admitted for rehabilitation in the five Traumatic Brain Injury (TBI) Model System projects. The incidence of specific intracranial hemorrhages, medical complications, and associated injuries are discussed. Two thirds of these individuals had one or more intracranial hemorrhages, the most common being subdural (32%) and subarachnoid (27%) hemorrhages. Persons with one or two intracranial hemorrhages were found to have significantly longer lengths of stay (LOS) in acute care compared to those with no hemorrhahges. One or more intracranial hemorrhages were found in persons injured by a fall (84%), while riding a bicycle (81%), while walking (76%), and by assault (73%). Of the nonhemorrhagic cerebral complications/problems investigated, seizures, cerebrospinal fluid (CSF) leak, and hydrocephalus were found to be related to extended LOS in acute care. Seizures were reported in 17% of patients, with 10% of all patients exhibiting a seizure within the first 24 hours postinjury. The extracerebral complications associated with longer LOS in acute care were respiratory failure, pneumonia, urinary tract infection, soft-tissue infection (STI), coagulopathy, renal failure, and septic shock. Persons injured in all-terrain vehicles, pedestrian/auto encounters, gunshot wounds to the head, and automobile crashes were more likely to have extracerebral complications than those injured by other causes. Fractures and cranial nerve injuries were the most common associated injuries. A larger proportion of persons injured in motor vehicle crashes, pedestrian/auto encounters, and bicycle accidents had associated injuries than those injured by other mechanisms.