Fecal Incontinence after Severe Brain Injury: A Barrier to Discharge after Inpatient Rehabilitation?

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Outcomes Research

Background:

• Severe acquired brain injuries (sABIs) frequently lead to complex neurological deficits.
• Fecal incontinence (FI) is a common but often overlooked symptom following sABIs.
• The impact of FI on functional recovery and discharge destination after sABI requires further investigation.

Purpose of the Study:

• To determine the incidence of fecal incontinence (FI) in patients with severe acquired brain injuries (sABIs).
• To assess the association between persistent FI and the ability to return home post-rehabilitation.
• To explore correlations between FI and neurological factors.

Main Methods:

• Retrospective observational cohort study of 521 acute sABI inpatients.
• Patients categorized into groups with and without FI at rehabilitation discharge.
• Primary endpoints: incidence of persistent FI and discharge destination differences.

Main Results:

• New-onset FI identified in 85% of patients upon admission; 62.7% had FI overall.
• At discharge, 53.3% of patients experienced persistent FI.
• Persistent FI correlated with frontal lesions, autonomic crises, and higher cognitive functioning scores (LCFS ≥3).
• Lower rates of persistent FI observed in patients discharged home (34%) compared to overall (53.3%).

Conclusions:

• Fecal incontinence (FI) is a persistent issue after severe acquired brain injuries (sABIs), even post-recovery from unconsciousness.
• FI should be viewed as a consequence of sABI, contributing to unfavorable outcomes.
• Addressing FI is crucial for improving rehabilitation success and home reintegration for sABI survivors.