Research Reports - Occurrence and predictive factors of heterotopic ossification in severe acquired brain injured patients during rehabilitation stay

Clin Rehabil. 2017 Aug 1:269215517723161. doi: 10.1177/0269215517723161. [Epub
ahead of print]

Bargellesi S(1), Cavasin L(2), Scarponi F(3), De Tanti A(4), Bonaiuti D(5),
Bartolo M(6), Boldrini P(7), Estraneo A(8); Heterotopic Ossification Cross
Sectional Survey group (HOCSS) *.

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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