Polytrauma associated with traumatic brain injury: incidence, nature and impact on rehabilitation outcome

The rehabilitation outcome of patients with severe traumatic brain injury (TBI) is well documented and is highly correlated to the neurobehavioural sequelae of CNS damage. However, many of these patients suffer from polytrauma involving systems other than the CNS and to systems involved in acquisition of external information. In the present series of 328 patients with severe TBI, 58% had associated trauma, mostly in the skeletal system. The presence of one single associated trauma had no additional effect on rehabilitation as evaluated by actual work placement. In contrast, multiple lesions were liked with a less favourable outcome, probably due to a greater severity of the initial CNS damage. Disturbances in the various information-acquiring systems (e.g. disturbances in eye movements, visual field defects and severe bilateral auditory deficits) were associated with poor outcome. Presence of peri-articular new bone formation and communicating hydrocephalus, usually associated with prolonged periods of unconsciousness, indicated a poor rehabilitation outcome as well.