Early Recovery Following Traumatic Brain Injury and Alcohol Withdrawal Management

• Published in: Rehabilitation psychology 2018-11, Vol.63 (4), p.588-594
• Main Authors: Klyce, Daniel W., Graham, Kristin M., Lacey, Russell W., Carter, William E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alcohol Withdrawal; Alcohol-Related Disorders - complications; Alcohol-Related Disorders - therapy; Amnesia; Analysis of Variance; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - rehabilitation; Female; Human; Humans; Inpatient; Institutional Release; Male; Middle Aged; Recovery of Function; Rehabilitation; Severity of Illness Index; Substance Withdrawal Syndrome - complications; Substance Withdrawal Syndrome - therapy; Traumatic Brain Injury; Treatment Outcome; Young Adult
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000240

Purpose: To compare recovery experienced during inpatient rehabilitation among individuals with traumatic brain injury (TBI) based on whether their acute care included the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol. Design: Participants included 234 individuals with TBI who completed inpatient rehabilitation at a TBI Model Systems site. Of these, 67 patients were treated using the CIWA protocol (TBI + CIWA); 167 patients were treated for TBI alone (TBI only). Demographic, injury, and treatment variables between the 2 groups were compared. A repeated-measures analysis of variance (ANOVA) compared Disability Rating Scale (DRS) scores between the groups at admission and discharge from inpatient rehabilitation. Results: The 2 groups did not significantly differ on DRS scores at admission to inpatient rehabilitation: TBI + CIWA, M = 9.6 (SD = 3.5) vs. TBI only, M = 10.1 (SD = 4.2). There was a significant difference in DRS scores at discharge, with the TBI + CIWA group having lower scores: TBI + CIWA, M = 6.4 (SD = 1.9) vs. TBI only, M = 7.0 (SD = 2.2). A repeated-measures ANOVA of DRS scores from admission to discharge revealed a significant between-subjects effect based on patients' Mississippi categorization of posttraumatic amnesia (PTA) duration (p < .001) and age (p = .016) but not based on their CIWA status (p = .068). A post hoc comparison including age as a covariate revealed a significant difference based on CIWA status (p = .013) within the "moderate" injury group at discharge, with the TBI + CIWA group having lower discharge DRS scores. Conclusions: Given the significant symptom overlap between alcohol withdrawal and PTA, it is likely that these 2 delirium presentations are confounded during the initial recovery from TBI, leading to "overestimation" of injury severity-particularly among individuals with moderate TBI. Impact and Implications Although associations between traumatic brain injury (TBI) and alcohol have been studied extensively, the impact of alcohol withdrawal during acute recovery from TBI is an area that requires further examination. The current study is among the first to describe the association between TBI and alcohol withdrawal, including use of the Clinical Institute Withdrawal Assessment (CIWA) protocol for symptom monitoring and management among this trauma population. The findings of this study will enhance rehabilitation providers' ability to discuss normative expectations for recovery from TBI with