Factors Affecting Who Receives Neuropsychological Testing Following Moderate-To-Severe Traumatic Bbrain Injury.

Philip Schatz, PhD.,Saint Joseph's University
Lucinda Hughes, M.S. Saint Joseph's University
Douglas L. Chute, PhD., Drexel University

We compared those who received evaluations against the 64% who received no formal evaluations on severity of injury and functional outcome variables. The two groups were observed to have equivalent Glasgow Coma Scale scores, length of loss of consciousness, and length of acute care hospital stay. ANOVA revealed a significant difference in functional outcome between those who did and did not receive neuropsychological evaluations; subjects receiving evaluations received significantly lower Disability Rating Scale scores than subjects receiving evaluations (7.2 vs. 5.7) [F(1,195)=4.48; p<.05].

We analyzed the relationship between attending more than one rehabilitation hospital and receiving neuropsychological testing. Chi2 analysis revealed that subjects who attended only one rehab facility were significantly less likely to receive neuropsychological evaluations (20% vs, 48%) [X² (1)=24.4; p<.0001], and significantly more likely to be discharged to the care of their family as compared to those attending more than one rehab (64% vs, 41%)[X² (1)=13.2; p<.0005]. Finally, subjects receiving evaluations within their first three years of rehabilitation were significantly more likely to be involved in litigation (37%) as compared to those not receiving evaluations (24%) [X² (1)=5.1; p<.025].

Results extend previous findings (Schatz & Chute, 1999) that following moderate-to-severe traumatic brain injury, only a discrete sample of subjects are chosen to receive neuropsychological evaluations. Results further suggest that a majority of these evaluations are likely to guide rehabilitation and discharge planning for subjects more likely to remain "in the system".

• Traumatic brain injury is the most common cause of neuropsychological referrals of individual's under the age of 40 years (Golden, Moses, Coffman, Miller, & Strider, 1983).
• It is widely accepted that following TBI, results of neuropsychological testing can assist in formulating treatment and rehabilitation plans, identify strengths and weaknesses, establish a baseline to which future progress can be compared (Lynch, 1983), determine appropriate employment, school, and residential placement, or to provide evidence of disability in lawsuits (Lezak, 1995).
• Despite the utility of formal neuropsychological assessment following TBI, not every patient receives such an evaluation. Past studies have examined the pattern of test usage in neuropsychological evaluations (Guilmette, Faust, Hart, & Arkes, 1990; Seretny, Dean, Gray, & Hartlage, 1986), specifically for forensic assessments (Lees-Haley, Smith, Williams & Dunn, 1996), and specifically for TBI populations (Horowitz, Schatz & Chute, 1997).
• The purpose of this study was to determine factors affecting which patients receive and benefit from neuropsychological assessments following TBI.

• Acute care and rehabilitation records were analyzed retrospectively for 500 moderate and severe TBI patients enrolled in a State-funded Head Injury Program.
• Inclusion in this study required that subjects had sustained a Traumatic Brain Injury, as diagnosed in comprehensive acute care, rehabilitation, and post-rehabilitation records, and had documentation of functional abilities at a minimum of 18 months post-injury.
• As a result of these criteria, 218 subjects were excluded, leaving 282 subjects in the study.
• Of these 282 subjects, only 36% (N=101) subjects received neuropsychological evaluations at any point in their rehabilitation.

• Subjects receiving evaluations received significantly lower Disability Rating Scale scores than subjects receiving evaluations (7.2 vs. 5.7) [F(1,195)=4.48; p<.05]. (Figure 1.)
• Subjects who attended only one rehab facility were significantly less likely to receive neuropsychological evaluations (20% vs, 48%) [X² (1)=24.4; p<.0001], and significantly more likely to be discharged to the care of their family as compared to those attending more than one rehab (64% vs, 41%) [X² (1)=13.2; p<.0005] (Figure 2).
• Subjects receiving a neuropsychological evaluation within their first three years of rehabilitation were significantly more likely to be involved in litigation (37%) as compared to those not receiving evaluations (24%) [X² (1)=5.1; p<.025] (Figure 3).

• Only 36% of subjects received neuropsych testing.
• Subjects receiving neuropsych testing were likely to attend more than one rehab hospital and had better functional outcomes.
• Subjects receiving neuropsych testing in the first three years post-injury were more likely to be involved in litigation.
• Following moderate-to-severe traumatic brain injury, only a discrete sample of subjects are chosen to receive neuropsychological evaluations.
• A majority of these evaluations are likely to guide rehabilitation and discharge planning for subjects more likely to remain "in the system".

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