Biomedical subjects

G Davidoff

Publications and source records attributed to G Davidoff.

23 records · Page 2Linked to original sources

PubMed1988

Galveston Orientation and Amnesia Test: its utility in the determination of closed head injury in acute spinal cord injury patients.

The incidence of closed head injury (CHI) associated with acute spinal cord injury (SCI) has been estimated at 40% to 50%. Closed head injury can be defined as the presence of loss of consciousness (LOC) and/or posttraumatic amnesia (PTA). Consequently, one of the difficulties in establishing a diagnosis of CHI is determining the existence of PTA in those patients without documented LOC. Previous work described the inconsistent evaluation of PTA in the SCI population. This study was conducted to evaluate the utility of the Galveston Orientation and Amnesia Test (GOAT) in establishing the diagnosis of CHI in a series of acute traumatic SCI patients. The GOAT was administered serially for three to five days to 34 patients admitted to our hospital. When information derived from the GOAT was added to that derived from review of medical records alone, the observed incidence of PTA (and by implication CHI) increased significantly (McNemar statistic = 6.4; p = 0.01). The GOAT is a quick, simple, and reproducible evaluation of spheres of orientation, which is extremely helpful in diagnosis of PTA in this population. This instrument should be used to evaluate patients at high risk for head injury. Although abnormalities in the GOAT evaluation may also be attributable to factors other than CHI (eg, hypoxia, medication effects), such findings provide evidence suggestive of CHI. This will help determine which patients require a more detailed neuropsychologic assessment.

Adult↗

PubMed1988

Patterns of referral to a university hospital consultation service: failure to accurately predict need for physiatric services.

The purpose of this study was to determine the predictive value of screening the narrative sections of the consultation request form to determine the need for physiatric intervention rather than PT intervention alone. We conducted a review of 107 requests for consultation from various acute care services at our hospital. After reviewing the referring physician's narrative summaries, we determined that 36% of 107 patients would require physiatric evaluation, and that the remaining patients could be "passed through" to PT for treatment. After evaluation of the medical records and examination of the patients, 54% of patients required physiatric assessment and only 45% could be "passed through" to PT. The hypothesis that this narrative information would be an adequate predictor of need for physiatric consultation was rejected at the p less than 0.005 level (chi 2 = 18.63; df = 1). In addition, the referring service indicated whether it wished PT or physiatry to evaluate the patient on the consultation form. The hypothesis that screening for the need for physiatric intervention by the indicated preference of the referral was rejected at the p less than 0.0005 level (chi 2 = 20.45; df = 1). We concluded that we could not reliably predict when patients required physiatric or only PT intervention based on the consultation request narrative. Ongoing physiatric involvement on a consultative basis, educational conferences, and other forms of education for house staff and attending physicians may serve to improve understanding of physiatric services and physiatric utilization.

Health Services Needs and Demand↗

PubMed1986

Assessment of closed head injury in trauma-related spinal cord injury.

The complete medical records of 122 patients who sustained traumatic spinal cord injuries were reviewed to determine the frequency and results of emergency room assessments for loss of consciousness (LOC) and post-traumatic amnesia (PTA). Eighty-eight percent of the patients were assessed for LOC and 19% were assessed for PTA. Fifty patients (41% of the total population) admitted to LOC, PTA or both. Fourteen of these 50 patients underwent subsequent radiographic examinations of the skull, all of which were negative. Because of the association of intracranial complications and long-term cognitive sequelae with even brief LOC or PTA, early recognition of craniocerebral trauma is an important component of the acute management of spinal cord injured patients.

Adolescent↗

PubMed1985

Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia.

Previous studies of trauma-related spinal cord injured patients suggest that 25% to 50% of these patients sustain a concomitant cranio-cerebral trauma. A loss of consciousness (LOC) of 20 minutes' duration or a post-traumatic amnesia (PTA) lasting 24 hours has been associated with deficits in concentration, attention, memory, and higher-level cognitive functions. These may present as significant factors influencing learning and adaptation during and after the formal rehabilitation process. A systematic review was performed of the medical records of 101 trauma-related spinal cord injured patients who were admitted to Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago within seven days of injury. The reported incidence of LOC and PTA in spinal cord injured patients was evaluated, and these data were compared with the level and etiology of injury, and with radiographic work-up, if any, for head injury. Eighty-seven percent of all emergency room admissions and 67% of all rehabilitation admissions were assessed for LOC. Fewer than 25% of all patients in both settings were assessed for PTA. Forty-two percent of all patients reported LOC, PTA, or both occurring simultaneously with the spinal cord injury. Assessment and incidence were unrelated to level of injury but were influenced by etiology. One-third of the patients who reported LOC, PTA, or both underwent further evaluation with computed tomographic (CT) scan or radiography of the skull. Assessment of LOC is conducted more consistently in the ER than in the rehabilitation setting. Assessment of PTA is performed infrequently despite its relevance to the rehabilitation process. Head injury may frequently be associated with traumatic spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1985

Cognitive dysfunction and mild closed head injury in traumatic spinal cord injury.

Previous investigators have reported that 25%-50% of traumatic spinal cord injury (SCI) patients sustain loss of consciousness (LOC), posttraumatic amnesia (PTA), or both concurrently with their SCI. A LOC of 20 minutes or less, or a PTA of 24 hours has been associated with prolonged time off work, and deficits in attention, concentration, memory, and judgment. Consequently, many traumatic SCI patients may also be the victims of a concomitant closed head injury (CHI) with cognitive sequelae. To test this hypothesis, a prospective study was conducted of 30 consecutive trauma-related SCI patients admitted to the Rehabilitation Institute of Chicago to determine the incidence of CHI and cognitive dysfunction (CD). The Halstead Category Test (HCT) was administered to each patient between 8 and 12 weeks after injury, and was considered abnormal if the patient committed 51 or more errors. Fifty-seven percent (n = 11) of all patients had abnormal HCT scores suggestive of higher level cognitive dysfunction. Patients with a new CHI had a mean HCT score of 65.2, as compared to 63.5 for patients with a premorbid CHI, and 46.3 for patients without a history of CHI. Although there was a trend toward higher HCT scores in patients who had any history of CHI, these differences did not reach statistical significance. The results of this study suggest that many trauma-related SCI patients are at risk for CD eight weeks after injury. Such cognitive abnormalities would be expected to impede rehabilitation and retard the requisite learning of new skills.

Adolescent↗