Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay: cross-sectional survey

Heterotopic Ossification Cross Sectional Survey group (HOCSS) *

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.

DESIGN: Multicentre cross-sectional survey.

SETTING: A total of 48 severe acquired brain injury rehabilitation institutes.

PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.

MAIN OUTCOME MEASURE: Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.

RESULTS: Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications.

CONCLUSION: Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.

Original languageEnglish
Pages (from-to)255-262
Number of pages8
JournalClinical Rehabilitation
Volume32
Issue number2
DOIs
Publication statusPublished - Feb 2018

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Heterotopic Ossification
Rehabilitation Centers
Rehabilitation
Brain Injuries
Cross-Sectional Studies
Brain
Coma
Ventilation
Blood Vessels
Joints

Keywords

  • Adolescent
  • Adult
  • Age Distribution
  • Brain Injuries, Traumatic/diagnosis
  • Comorbidity
  • Cross-Sectional Studies
  • Female
  • Glasgow Coma Scale
  • Humans
  • Incidence
  • Injury Severity Score
  • Italy
  • Male
  • Middle Aged
  • Ossification, Heterotopic/diagnosis
  • Predictive Value of Tests
  • Prognosis
  • Rehabilitation Centers
  • Risk Assessment
  • Sex Distribution
  • Treatment Outcome
  • Young Adult

Cite this

Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay : cross-sectional survey. / Heterotopic Ossification Cross Sectional Survey group (HOCSS) * .

In: Clinical Rehabilitation, Vol. 32, No. 2, 02.2018, p. 255-262.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.DESIGN: Multicentre cross-sectional survey.SETTING: A total of 48 severe acquired brain injury rehabilitation institutes.PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.MAIN OUTCOME MEASURE: Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.RESULTS: Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6{\%}) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3{\%} traumatic, 19.2{\%} anoxic, 11.7{\%} vascular and 11.5{\%} other). Prevalence was significantly higher in patients with diffuse (23.3{\%}) rather than focal brain lesions (12.4{\%}) or unspecified lesions (11.2{\%}; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6{\%} versus 11.6{\%}; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7{\%} versus 10.1{\%}; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications.CONCLUSION: Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.",
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author = "Stefano Bargellesi and Luisa Cavasin and Federico Scarponi and {De Tanti}, Antonio and Donatella Bonaiuti and Michelangelo Bartolo and Paolo Boldrini and Anna Estraneo and {Heterotopic Ossification Cross Sectional Survey group (HOCSS) *}",
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T1 - Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay

T2 - cross-sectional survey

AU - Bargellesi, Stefano

AU - Cavasin, Luisa

AU - Scarponi, Federico

AU - De Tanti, Antonio

AU - Bonaiuti, Donatella

AU - Bartolo, Michelangelo

AU - Boldrini, Paolo

AU - Estraneo, Anna

AU - Heterotopic Ossification Cross Sectional Survey group (HOCSS)

PY - 2018/2

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N2 - OBJECTIVES: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.DESIGN: Multicentre cross-sectional survey.SETTING: A total of 48 severe acquired brain injury rehabilitation institutes.PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.MAIN OUTCOME MEASURE: Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.RESULTS: Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications.CONCLUSION: Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.

AB - OBJECTIVES: To report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.DESIGN: Multicentre cross-sectional survey.SETTING: A total of 48 severe acquired brain injury rehabilitation institutes.PARTICIPANTS: Traumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.MAIN OUTCOME MEASURE: Occurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.RESULTS: Heterotopic ossification occurred around one or more joints in 94/689 patients (13.6%) with a significantly higher prevalence in young males. Occurrence did not significantly differ in relation to aetiology (16.3% traumatic, 19.2% anoxic, 11.7% vascular and 11.5% other). Prevalence was significantly higher in patients with diffuse (23.3%) rather than focal brain lesions (12.4%) or unspecified lesions (11.2%; chi-square = 7.81, df = 2, P = 0.020); longer duration of coma ( P = 0.0016) and ventilation support ( P = 0.0145); paroxysmal sympathetic hyperactivity (22.6% versus 11.6%; chi-square = 10.81, df = 1, P = 0.001); and spasticity (22.7% versus 10.1%; chi-square = 18.63, df = 1, P < 0.0001). A longer interval between acute brain injury and admission to rehabilitation centre was significantly associated with higher frequency of heterotopic ossifications.CONCLUSION: Occurrence of heterotopic ossifications is frequent in patients with severe traumatic and non-traumatic brain-injury in rehabilitation centres. Our study confirms male gender, young age, paroxysmal sympathetic hyperactivity, spasticity, longer duration of coma and ventilation and longer interval between brain injury onset and admission to rehabilitation centre as possible risk factors. Further studies are necessary to investigate the role of early appropriate rehabilitation pathways to reduce occurrence of heterotopic ossifications.

KW - Adolescent

KW - Adult

KW - Age Distribution

KW - Brain Injuries, Traumatic/diagnosis

KW - Comorbidity

KW - Cross-Sectional Studies

KW - Female

KW - Glasgow Coma Scale

KW - Humans

KW - Incidence

KW - Injury Severity Score

KW - Italy

KW - Male

KW - Middle Aged

KW - Ossification, Heterotopic/diagnosis

KW - Predictive Value of Tests

KW - Prognosis

KW - Rehabilitation Centers

KW - Risk Assessment

KW - Sex Distribution

KW - Treatment Outcome

KW - Young Adult

U2 - 10.1177/0269215517723161

DO - 10.1177/0269215517723161

M3 - Article

C2 - 28805078

VL - 32

SP - 255

EP - 262

JO - Clinical Rehabilitation

JF - Clinical Rehabilitation

SN - 0269-2155

IS - 2

ER -