Development and Validation of a Functionally Relevant Comorbid Health Index in Adults Admitted to Inpatient Rehabilitation for Traumatic Brain Injury
dc.contributor.author | Kumar, Raj G. | |
dc.contributor.author | Zhong, Xiaobo | |
dc.contributor.author | Whiteneck, Gale G. | |
dc.contributor.author | Mazumdar, Madhu | |
dc.contributor.author | Hammond, Flora M. | |
dc.contributor.author | Egorova, Natalia | |
dc.contributor.author | Lercher, Kirk | |
dc.contributor.author | Dams-O’Connor, Kristen | |
dc.contributor.department | Physical Medicine and Rehabilitation, School of Medicine | |
dc.date.accessioned | 2023-10-23T13:31:13Z | |
dc.date.available | 2023-10-23T13:31:13Z | |
dc.date.issued | 2022 | |
dc.description.abstract | Several studies have characterized comorbidities among individuals with traumatic brain injury (TBI); however, there are few validated TBI comorbidity indices. Widely used indices (e.g., Elixhauser Comorbidity Index [ECI]) were developed in other patient populations and anchor to mortality or healthcare utilization, not functioning, and notably exclude conditions known to co-occur with TBI. The objectives of this study were to develop and validate a functionally relevant TBI comorbidity index (Fx-TBI-CI) and to compare prognostication of the Fx-TBI-CI with the ECI. We used data from the eRehabData database to divide the sample randomly into a training sample (N = 21,292) and an internal validation sample (N = 9166). We used data from the TBI Model Systems National Database as an external validation sample (N = 1925). We used least absolute shrinkage and selection operator (LASSO) regression to narrow the list of functionally relevant conditions from 39 to 12. In internal validation, the Fx-TBI-CI explained 14.1% incremental variance over an age and sex model predicting the Functional Independence Measure (FIM) Motor subscale at inpatient rehabilitation discharge, compared with 2.4% explained by the ECI. In external validation, the Fx-TBI-CI explained 4.9% incremental variance over age and sex and 3.8% over age, sex, and Glasgow Coma Scale score,compared with 2.1% and 1.6% incremental variance, respectively, explained by the ECI. An unweighted Sum Condition Score including the same conditions as the Fx-TBI-CI conferred similar prognostication. Although the Fx-TBI-CI had only modest incremental variance over demographics and injury severity in predicting functioning in external validation, the Fx-TBI-CI outperformed the ECI in predicting post-TBI function. | |
dc.eprint.version | Final published version | |
dc.identifier.citation | Kumar RG, Zhong X, Whiteneck GG, et al. Development and Validation of a Functionally Relevant Comorbid Health Index in Adults Admitted to Inpatient Rehabilitation for Traumatic Brain Injury. J Neurotrauma. 2022;39(1-2):67-75. doi:10.1089/neu.2021.0180 | |
dc.identifier.uri | https://hdl.handle.net/1805/36558 | |
dc.language.iso | en_US | |
dc.publisher | Mary Ann Liebert | |
dc.relation.isversionof | 10.1089/neu.2021.0180 | |
dc.relation.journal | Journal of Neurotrauma | |
dc.rights | Publisher Policy | |
dc.source | PMC | |
dc.subject | Comorbidities | |
dc.subject | Functioning | |
dc.subject | Prognostication | |
dc.subject | Traumatic brain injury | |
dc.title | Development and Validation of a Functionally Relevant Comorbid Health Index in Adults Admitted to Inpatient Rehabilitation for Traumatic Brain Injury | |
dc.type | Article | |
ul.alternative.fulltext | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8917887/ |