Comorbidity in traumatic brain injury and functional outcomes: a systematic review.
Sara Hanafy, Chen Xiong, Vincy Chan and 4 others
PMID 33541041WHAT IT FOUND
Most studies found that having additional medical or psychiatric conditions alongside traumatic brain injury predicts poorer recovery.
However, results were inconsistent across conditions, and standard comorbidity scores often failed to capture this impact.
Key findings
01All but five of the 22 included studies showed that comorbidity associates with worse functional outcomes, though the strength of this association varied significantly between studies.
02Specific conditions like diabetes, hypertension, and a history of psychiatric disorders were frequently associated with worse motor and cognitive recovery trajectories, while others like stroke showed no consistent association.
03Standard comorbidity indices like the Charlson Comorbidity Index and Elixhauser Score Index showed inconsistent or weak associations with functional outcomes, suggesting they may not be sensitive enough for this population.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
High heterogeneity across the 22 studies in terms of comorbidity definitions, outcome measures, and timing of assessment made direct comparison difficult. Most included studies were retrospective or prospective cohorts, not randomized trials, limiting causal inference. Standard comorbidity indices (Charlson, Elixhauser) were not developed for TBI populations and may lack sensitivity. The review excluded non-English articles and studies with low quality ratings. Confounding variables (age, sex, injury severity) were adjusted for differently across studies, potentially attenuating or masking true associations.
Declared interests
None reported in the provided text.
The easy way to misread this
Do not assume that a low score on a standard comorbidity index (like the Charlson) means a patient has no barrier to recovery. The review found these indices often failed to predict functional outcomes in TBI, while specific conditions like diabetes or depression did show associations.