Journal of Rehabilitation Medicine 51-4inkOmslag | Page 32

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A. Tölli et al.
The Rancho Los Amigos Cognitive Scale-Revised
(RLAS-R) (25) was used to categorize level of cognitive
and behavioural function. RLAS-R scores from 1 to 10
represent 10 stages of recovery after brain injury, as re-
flected by the ability to follow commands, the presence
of non-purposeful behaviour, cooperation, confusion,
attention to environment, verbal ability, memory, orien-
tation and higher cognitive ability. RLAS-R levels were
dichotomized into ”inferior functioning” (RLAS-R 1–8)
and ”superior functioning” (RLAS-R 9–10).
The Glasgow Outcome Scale Extended (GOSE) was
used to assess global outcome and independence (5). The
8 categories extend from ”Dead” (score 1) to ”Upper Good
Recovery” (score 8). GOSE scores were dichotomized into
”unfavourable outcome” (GOSE 1–4) and ”favourable
outcome” (GOSE 5–8).
Baseline
TBI + SAH
n = 127 (82 + 45)
dead n =14
moved abroad n = 4
declined n = 7
3 months
n = 102 (64 + 38)
declined n = 6
6 months
n = 96 (61 + 35)
moved abroad n = 1
declined n = 4
12 months
n = 91 (56 + 35)
Fig. 1. Flow chart of study participants.
Statistical analysis
Statistical analysis was performed using IBM SPSS
Statistics version 25 (IBM Corp., Armonk, New York, USA).
Descriptive data comprise central measures (mean, median or
percent) and measures of spread (SD, percentile, min–max).
Non-parametric methods were used, as data were not normally
distributed according to Shapiro–Wilk’s test of normality.
Mann–Whitney U test was used for group comparisons of
GCS, peak S100B (12–36 h), and comparisons of results of
BNIS, RLAS-R and GOSE between 2 subgroups of hormone
dysfunction. Pearson χ 2 test was used for group comparisons of
sex, severity of injury, age groups, and anterior pituitary dys-
function. Fisher’s exact test was used for comparisons of pupil
reaction to light stimulation at admission. Kruskal–Wallis test
was used for multiple comparisons of results of BNIS, RLAS-R
and GOSE between 3 subgroups of hormone dysfunction. Ana-
lysis of variance (ANOVA) was used for group comparisons of
age and body mass index (BMI). Spearman’s correlation coef-
ficient was used for analysis of bivariate correlation between
hormone dysfunction and BNIS.
Multiple linear regression analyses were used to examine the
relationship between BNIS or RLAS or GOSE and hormone
dysfunctions, GCS, sex and age. In all cases, significance level
was set at p < 0.05. BMI (p = 0.893), while there was significant difference
in age (p = 0.001) and sex (p < 0.001).
PiDs were frequent and comprised all hormone axes,
as shown in Tables II–IV. Most PiDs were singular.
Multiple (2 or more) PiDs occurring at the same time in
individual patients were observed in 7 (8%) in the acute
stage, in 1 (1%) at 3 months, in 3 (3%) at 6 months
and in 3 (3%) at 12 months’ follow-up. The results of
comparisons of subgroups with normal, low or high
hormone levels are shown in Tables II–IV.
RESULTS Table I Baseline data of patients with traumatic brain injury (TBI)
and aneurysmal subarachnoid haemorrhage (aSAH)
BNIS and pituitary dysfunction
Data are displayed in Table II. At 12 months’ follow-
up, in total 16% (15/91) patients failed pre-screen of
BNIS. Of those who performed the BNIS test, in total
35% (32/91) patients scored below cut-off for cognitive
dysfunction (T-points < 40).
Study sample
Out of 127 patients, 82 with TBI and 45 with
SAH, data from 91 patients were available
for analyses (Fig. 1). Drop-outs did not differ
from retained study participants regarding sex
(p = 0.121/p = 0.095), age (p = 0.094/p = 0.280) or GCS
scores (p = 0.073/p = 0.205).
Demographic and clinical characteristics
Data are displayed in Table I. Of the 91 patients, (49
men, 42 women, mean age 51.0 years (SD 15.2)), 66
had a severe and 25 patients had a moderate brain
injury according to the admission GCS score. There
was no significant difference between patients with
TBI or with aSAH regarding GCS scores (p = 0.144),
www.medicaljournals.se/jrm
TBI
n  = 56
aSAH
n  =35
TBI and aSAH
n  =91
Age, years, mean (SD) 47.1 (16.6) 57.4 (9.9)
51.0 (15.2)
[min–max]
BMI, mean (SD) [19–79]
25.6 (4.8)
[19–79]
25.6 (4.6)
[min–max]
GCS, mean (SD) [18.5–42.2] [20.3–36.5] [18.5–42.2]
6.3 (2.9)
7.9 (4.2)
6.9 (3.5)
[min–max]
GCS, median (Q1–Q3)
Age groups, n (%)
18–59 years
60–69 years
70–87 years
Sex, n (%)
Male
Female
GCS, n (%)
Moderate (9–13)
Severe (3–8)
[3–13]
6 (4–8)
[28–76]
25.7 (4.3)
[3–13]
7 (3–13)
[3–13]
6 (4–9)
40 (71.4)
13 (23.2)
3 (5.4) 19 (54.3)
15 (42.9)
1 (2.9) 59 (64.8)
28 (30.8)
4 (4.4)
41 (73.2)
15 (26.8) 8 (22.9)
27 (77.1) 49 (53.8)
42 (46.2)
12 (21.4)
44 (78.6) 13 (37.1)
22 (62.9) 25 (27.5)
66 (72.5)
BMI: body mass index (kg/m 2 ); SD: standard deviation; GCS: Glasgow Coma
Score; Q1, (25 th percentiles); Q3, (25 th percentiles).