S141 S290
Thursday, October 12, 2017
2:00 PM
e
3:30 PM
Room 705, Meeting Room Level
PAST, PRESENT AND FUTURE OF PEDIATRIC REHABILITATION
MEDICINE: RESEARCH UPDATES AND STATE OF THE FIELD
Poster 134:
Evaluation of the Children’s Affective Lability Scales
(CALS) in a Pilot Sample of Children with Traumatic
Brain Injury
Mi Ran Shin, MD (Johns Hopkins University School of Med),
Stacy J. Suskauer, MD
Disclosures:
Mi Ran Shin: I Have No Relevant Financial Relationships
To Disclose
Objective:
To describe, in a pilot group of children with milder
traumatic brain injury (TBI), scores on the Children’s Affective Lability
Scale (CALS) at 2 and 12 months post-injury and their relationship to
parent-report of executive functioning and child’s quality of life.
Design:
Longitudinal observational study.
Setting:
Pediatric rehabilitation hospital.
Participants:
Seventeen children aged 10-17 years at injury with mild-
complicated TBI (mTBI) (n
¼
7), moderate (n
¼
9) or severe (n
¼
1) TBI; 14
returned for re-evaluation 12 months post-injury.
Interventions:
Not applicable.
Main Outcome Measures:
Children’s Affective Lability Scale (CALS)
(2 and 12 months), Behavior Rating Inventory of Executive Function
(BRIEF) (2 and 12 months) : Behavioral Regulation Index (BRI),
Metacognition Index (MI), Global Executive Composite (GEC) and
Pediatric Quality of Life inventory (PedsQL): Emotional health (12
months only).
Results:
2 months post-injury, 2 of 17 children (both with mTBI) had
CALS scores above the mean for outpatient psychiatric patients. No
child had elevated scores 12 months post-injury. Mean CALS scores
for the TBI cohort was within the normal range and decreased over
time (at 2 month, mean 9.59, SD
¼
9.71; at 12 months mean 3, SD
3.62; p
<
.05). CALS score was strongly correlated with BRI at both
time points (2months r
¼
0.914, p
<
.01;12 months r
¼
0.675, p
<
.01),
with more affective lability associated with worse behavioral
regulation). CALS scores were negatively correlated with emotional
quality of life from the PedsQL (r
¼
-0.893, p
<
.01), with more af-
fective lability associated with worse emotional quality of life at 12
months.
Conclusions:
The CALS identified clinically elevated affective lability
in a subset of children with milder TBI as well as improvements in
affective lability over the first-year post-injury. As affective lability
after TBI is associated with, difficulties with behavior regulation and
emotional quality of life, the CALS may represent a useful brief screen
for identifying youth who would benefit from additional resources for
care.
Level of Evidence:
Level II
Saturday, October 14, 2017
8:00 AM
e
9:15 AM
Room 705, Meeting Room Level
LEADING IN RESEARCH: PRACTICE MANAGEMENT,
LEADERSHIP, AND QUALITY IMPROVEMENT RESEARCH
PODIUM SESSION
Poster 148:
Beating the Weekend Trend: Increased Mortality in
Older Adult Traumatic Brain Injury (TBI) Patients
Admitted on Weekends
Salman Hirani, MD (Icahn School of Medicine at Mount Sinai, New
York, NY, United States)
Disclosures:
Salman Hirani: I Have No Relevant Financial Relationships
To Disclose
Objective:
Weekend admission is a/w mortality in cardiovascular
emergencies and stroke but the effect of weekend admission for TBI is
not defined. We sought to determine whether differences in mortality
outcomes existed for older adults with substantial TBI admitted on a
weekday versus the weekend.
Design:
Data from the 2006, 2007, and 2008 Nationwide Inpatient
Sample (NIS) were combined and head trauma admissions were iso-
lated. Abbreviated injury scale (AIS) scores were calculated using
ICDMAP-90 Software. Wilcoxon rank sum and Student t-tests compared
demographics, length of stay, and total charges for weekday versus
weekend admissions.
c
2 tests compared sex and head injury severity.
Logistic regression modeled mortality adjusting for age, sex, injury
severity, comorbidity, and insurance status.
Setting:
NIS.
Participants:
Individuals aged 65 to 89, with head AIS of 3 or 4 and no
other region score
<
3 were included. Individual Charlson comorbidity
scores were calculated and individuals with missing mortality, sex, or
insurance data were excluded.
Interventions:
Not applicable.
Main Outcome Measures:
Mortality, LOS, Hospital Charges,
Comorbidity.
Results:
Of 38,675 patients meeting criteria, 9937 (25.6%) were
admitted on weekends. Mean age was similar (78.4 versus 78.4,
P
¼
.796) but more weekend admissions were female (51.6% versus
50.2%, P
¼
.022). Weekend patients demonstrated slightly lower co-
morbidity (mean Charlson
¼
1.07 versus 1.14, P
<
.001) and head injury
severity (58.3% versus 60.8% AIS
¼
4, P
<
.001). Median weekend length
of stay was shorter (4 versus 5 d, P
<
.001). Weekend and weekday
median total charges did not differ ($27,128 versus $27,703, respec-
tively, P
¼
.667). Proportional mortality was higher among weekend
patients (9.3% versus 8.4%, P
¼
.008). After adjustment, weekend pa-
tients demonstrated 14% increased odds of mortality (OR 1.14, 95% CI
1.05-1.23).
Conclusions:
Older adults with substantial TBI admitted on weekends
are less injured, carry less comorbidity, and generate similar charges
compared with those admitted on weekdays. However, after ac-
counting for known risk confounders, weekend patients demonstrated
14% greater odds of mortality.
Level of Evidence:
Level II
Poster 153:
The Evaluation of Inpatient Rehabilitation Facility
Patient Falls with Imaging Studies: A Quality
Improvement Project
Kirill Alekseyev, MD, EMBA (Kingsbrook Jewish Med Cntr, Brooklyn,
NY, United States), Malcolm Lakdawala, MD, Marc K. Ross, MD
Disclosures:
Kirill Alekseyev: I Have No Relevant Financial Relation-
ships To Disclose
Objective:
1) To identify the clinical significance of ordering a head
CT scan after an acute inpatient fall. 2) Implement multidisciplinary
changes to improve the effectiveness of ordering imaging studies for
inpatient falls. 3) Identify a cost analysis of CT scans that were con-
ducted, which revealed no intracranial findings.
Design:
Retrospective chart review.
Setting:
Inpatient rehabilitation facility of an inner-city hospital.
Participants:
A total of 379 patient falls (n
¼
379) documented during
an inpatient hospital course.
Interventions:
Retrospective chart review over a 5-year period
(January 2012 to November 2016) of all inpatient rehabilitation facility
falls that had a head CT scan. Charts were reviewed for the following:
head CT revealing any evidence of intracranial injury as a consequence
of the fall, and the results from the physical examination following
S141
Abstracts / PM R 9 (2017) S131-S290