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

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.

Keywords

Heterotopic ossification rehabilitation severe acquired brain injury

Get full access to this article

View all access options for this article.

References

Teasdale

Jennet

Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2: 81–84.

De Tanti

Zampolini

Pregno

; on behalf of the CC3 Group. Recommendations for clinical practice and research in severe brain injury in intensive rehabilitation: the Italian Consensus Conference. Eur J Phys Rehabil Med 2015; 51(1): 89–103.

Vandenbossche

Vanderstraeten

Heterotopic ossification: a review. J Rehabil Med 2005; 37: 129–136.

Van Kampen

Martina

Vos

et al . Potential risk factors for developing heterotopic ossification in patients with severe traumatic brain injury. J Head Trauma Rehabil 2011; 26: 384–391.

Dizdar

Tiftik

Kara

et al . Risk factors for developing heterotopic ossification in patients with traumatic brain injury. Brain Inj 2013; 27: 807–811.

Davies

Grover

Eisenstein

et al . Identifying the cellular mechanisms leading to heterotopic ossification. Calcif Tissue Int 2015; 97: 432–444.

Watanabe

Sant

MO.

Common medical complications of traumatic brain injury. Phys Med Rehabil 2001; 15: 283–299.

Genêt

Jourdan

Schnitzler

et al . Troublesome heterotopic ossification after central nervous system damage: a survey of 570 surgeries. PLoS ONE 2011; 6: e16632.

Teasell

Janzen

Cassidy

et al . Heterotopic ossification and venous thromboembolism. London Erabi (Evidence-based review of moderate to severe acquired brain injury); Module 11, 2014, http://www.abiebr.com

10.

Kaplan

Glaser

Hebela

et al . Heterotopic ossification. J Am Acad Orthop Surg 2004; 12: 116–125.

11.

Sullivan

Torres

Mehta Sand Ahn

Heterotopic ossification after central nervous system trauma: a current review. Bone Joint Res 2013; 3: 51–57.

12.

Reznik

Biros

Marshall

et al . Prevalence and risk-factors of neurogenic heterotopic ossification in traumatic spinal cord and traumatic brain injured patients admitted to specialized units in Australia. J Musculoskelet Neuronal Interact 2014; 14: 19–28.

13.

Ranganathan

Peterson

Agarwal

et al . Role of gender in burn-induced heterotopic ossification and mesenchymal cell osteogenic differentiation. Plast Reconstr Surg 2015; 135: 1631–1641.

14.

Ivanhoe

Durand-Sanchez

Spier

ET.

Acute rehabilitation. In: Zasler

Katz

Zafonte

(eds) Brain injury medicine. New York: Demos Medical Publishing, 2012, pp. 385–405.

15.

Hendricks

Geurts

ACH

van Ginneken

et al . Brain injury severity and autonomic dysregulation accurately predict heterotopic ossification in patients with traumatic brain injury. Clin Rehabil 2007; 21: 545–553.

16.

Citak

Suero

Backhaus

et al . Risk factors for heterotopic ossification in patients with spinal cord injury. Spine 2012; 37: 1935–1937.

17.

Gouvier

Blanton

LaPorte

et al . Reliability and validity of the disability rating scale and the level of cognitive functioning scale in monitoring recovery from head injury. Arch Phys Med Rehabil 1987; 68: 94–97.

18.

Rappaport

Hall

Hopkins

et al . Disability rating scale for severe head trauma: coma to community. Arch Phys Med Rehabil 1982; 63: 118–123.

19.

Baguley

Perkes

Fernandz-Ortega

JF.

Paroxysmal sympathetic hyperactivity after acquired brain injury: consensus on conceptual definition, nomenclature, and diagnostic criteria. J Neurotrauma 2014; 31: 1515–1520.

20.

Bohannon

Smith

Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207.

21.

Winkler

Niedermair

Füchtmeier

et al . The impact of hypoxia on mesenchymal progenitor cells of human skeletal tissue in the pathogenesis of heterotopic ossification. Int Orthop 2015; 39: 2495–2501.

22.

Gennarelli

TA.

Heterotopic ossification. Brain Inj 1988; 2: 175–178.

23.

Pape

Marsh

Morley

et al . Current concepts in the development of heterotopic ossification. J Bone Joint Surg Br 2004; 86: 783–787.

24.

Wittenberg

Peschke

Botel

Heterotopic ossification after spinal cord injury. Epidemiology and risk factors. J Bone Joint Surg Br 1992; 74: 215–218.

25.

Godbolt

Stenberg

Lindgren

et al . Associations between care pathways and outcome 1 year after severe traumatic brain injury. J Head Trauma Rehabil 2015; 30: E41–E51.

26.

Godbolt

Stenberg

Jakobsson

et al . Subacute complications during recovery from severe traumatic brain injury: frequency and associations with outcome. BMJ 2015; 5: e007208.

27.

Bartolo

Bargellesi

Castioni

et al . Early rehabilitation for severe acquired brain injury in intensive care unit: multicenter observational study. Eur J Phys Rehabil Med 2016; 52: 90–100.

28.

Cameron

Ball

Cepinskas

et al . Early mobilization in the critical care unit: a review of adult and pediatric literature. J Crit Care 2015; 30: 664–672.

29.

Castro-Avila

Serón

Fan

et al . Effect of early rehabilitation during intensive care unit stay on functional status: systematic review and meta-analysis. PLoS ONE 2015; 10: e0130722.

30.

Formisano

Azicnuda

Kansefid

et al . Early rehabilitation: benefits in patients with severe acquired brain injury. Neurol Sci 2017; 38: 181–184.

31.

Taricco

De Tanti

Boldrini

et al . National Consensus Conference. The rehabilitation management of traumatic brain injury patients during the acute phase: criteria for referral and transfer from intensive care units to rehabilitative facilities (Modena June 20–21, 2000). Eura Medicophys 2000; 42: 73–84.

32.

Estraneo

Moretta

Loreto

et al . Clinical and neuropsychological long-term outcomes after late recovery of responsiveness: a case series. Arch Phys Med Rehabil 2014; 95: 711–716.

33.

Garland

Razza

Waters

RL.

Forceful joint manipulation in head-injured adults with heterotopic ossification. Clin Orthop Relat Res 1982; 169: 133–138.

34.

Ozçakar

Carli

Tok

et al . The utility of musculoskeletal ultrasound in rehabilitation settings. Am J Phys Med Rehabil 2013; 92: 805–817.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.20 MB