Session Information
Date: Friday, November 15, 2019
Session Title: Neurological Rehabilitation Case and Research Report
Session Time: 12:30pm-2:00pm
Location: Research Hub - Kiosk 5
Disclosures: Ana N. Henriques: Nothing to disclose
Case Description: A 37-year-old male sustained a severe traumatic brain injury (TBI) at a karate event that required emergent left craniectomy leaving him in a comatose state. Rehabilitation medicine was consulted on day 10 for medical and rehabilitation recommendations. Due to functional limitations that accompany disorders of consciousness (DOC), he did not meet criteria for an acute inpatient rehabilitation facility (IRF). Due to social complexities including a lack of insurance, a suitable post-hospitalization location could not be identified. Therefore, while hospitalized on the neurosurgery service (46 total days) which included cranioplasty on day 39, the rehabilitation consultation team directed TBI specific management including multiple neurostimulants and progressive therapies. Emergence through the DOC spectrum was assessed utilizing the JKF-Coma Recovery Scale – Revised, and the patient emerged on day 45 from a minimally conscious state (MCS). On day 46, he was transferred to an acute IRF and completed a 2-week course before being discharged home at a Rancho Los Amigos level V.
Setting: Inpatient rehabilitation at an academic hospital.
Patient: A 37-year-old male with a traumatic brain injury.
Assessment/Results: Early and ongoing involvement of physiatry in a comatose patient over an atypically extended hospital stay facilitated emergence from a MCS and immediate admission to acute IRF.
Discussion: This case demonstrates the potential of an integrated rehabilitation consult service to optimize patients medically and functionally despite limitations in transferring to acute IRF. This patient’s social limitations to discharge to an extended care facility presented a unique opportunity for rehab medicine to direct a DOC rehabilitation program for 36 consecutive days in the acute hospital until the patient was an appropriate IRF candidate.
Conclusion: DOC acute rehabilitation programs have been effective in the Veterans Affairs Polytrauma System of Care and can be modeled after in an academic hospital. The importance of physiatry involvement early in a hospitalization cannot be overstressed.
Level of Evidence: Level V
To cite this abstract in AMA style:
Henriques AN, Leet JG, Harden JK, Allred DB. Outcome in a Comatose Patient with Continuous Stay in the Acute Hospital Setting: A Case Report [abstract]. PM R. 2019; 11(S2)(suppl 2). https://pmrjabstracts.org/abstract/outcome-in-a-comatose-patient-with-continuous-stay-in-the-acute-hospital-setting-a-case-report/. Accessed May 4, 2025.« Back to AAPM&R Annual Assembly 2019
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/outcome-in-a-comatose-patient-with-continuous-stay-in-the-acute-hospital-setting-a-case-report/