Evaluation of functionality after head injury in adolescents

The Occupational Therapy Head Injury Mini Screen (OT HIMS) is a screening tool for patients admitted with traumatic brain injury (TBI) in the acute care setting. It is a combination of the Galveston Orientation and Amnesia Test (GOAT) and the Cognistat (formally the Neurobehavioral Cognitive Status Examination). Its purpose is to identify cognitive deficits in patients and to provide education for patients on the impact of these deficits on daily living. Our hypothesis for this study was that cognitive functionality outcome varies with severity of head injury (manifested by Glasgow Coma Scale [GCS]) at admission and tests that identify cognitive deficits can be reserved for patients admitted with severe head injury.

Data were prospectively collected for all patients with TBI (DRG International Classification of Diseases-9th Rev.-Clinical Modification codes 800.0-801.99 + 850-859.9), aged 13-21 years, over 10 years. The inclusion criteria are patients had to be awake and have adequate physical function to complete the test. Patients with cognitive deficits were identified using GOAT and Cognistat. Preexistent deficits were also identified. Scores on OT HIMS were compared with GCS at admission. Outcomes also included discharge to home or rehabilitation centers. Hospital deaths were not included in the study.

Six hundred nine patients were reviewed, and 248 were administered the OT HIMS. Eighty-three suffered some impairment. The mean GCS for the 248 patients was 13.96 (+/-2.16). A coefficient of correlation between GCS and GOAT score of only 0.224 and an R2 value of 0.050 indicated no correlation between these results. Comparing GCS and the presence of impairment identified by Cognistat yielded an R2 value of 0.093, indicating no correlation between these parameters. Among the patients whose results showed cognitive deficits on OT HIMS, 38% had impairments before injury. Interestingly, only 58% of patients with deficits before injury also demonstrated impairments on OT HIMS. Of the 248 patients, 12 went to rehabilitation centers and this was not correlated with GCS.

In this study, admission GCS did not predict performance on the OT HIMS after injury in this cohort of patients with adequate recovery to take the examination. Cognitive functionality can be impaired after TBI of even minimal degree. All patients admitted for TBI should be screened for cognitive deficits before discharge. Long-term follow-up for this group must be performed for maximal therapy and optimal outcomes.