Characterizing Comorbid Cerebrovascular Insults Among Patients With TBI at a TBI Model Systems Rehabilitation Center

Objective: Determine incidence and predictors of comorbid cerebrovascular injuries in patients with moderate to severe traumatic brain injury (TBI) and whether it influences rehabilitation outcomes. Setting: Inpatient Rehabilitation Facility (IRF) brain injury unit participating in NIDILRR TBI Model Systems (TBIMS). Participants: A total of 663 patients with moderate to severe TBI. Design: Observational study with prospective and retrospective data collection. Main Measures: New traumatic cerebral artery injury (TCAI) lesions of head/neck and new cerebral infarcts (CIs) abstracted from neuroimaging reports and clinical notes. Results: The incidence of comorbid CI was 8%, among whom 19% also had TCAI identified. The incidence of TCAI increased over time from 2% before 2008 to 10% after, probably from greater screening. Both CI and TCAI were associated with longer acute care stay. Cerebral infarct was also associated with longer posttraumatic amnesia and lower rate of functional gains. Conclusions: Using in-depth abstraction of imaging findings, the incidence of traumatic head/neck artery injuries, and CIs in patients with moderate to severe TBI were both higher than a recent TBIMS-wide study utilizing ICD coding. Cerebral infarct was associated with longer posttraumatic amnesia duration and slower functional gains. Further research is recommended on the outcome implications of concomitant cerebrovascular injury in patients with TBI.