Double Trouble - The prevalence of concomitant traumatic brain injury in patients with spinal cord injury and its impact on functional outcomes: a systematic review.

Study designSystematic review ObjectivesTo examine the prevalence, diagnostic challenges, and functional impact of concomitant traumatic brain injury (TBI) in individuals with traumatic spinal cord injury (SCI). MethodsPubMed, Embase and Scopus databases were searched with a search strategy containing key search terms for TBI, SCI and concomitant injury. Original research articles reporting on prevalence and/or functional outcomes following a TBI at the time of SCI in adult populations were included. ResultsForty studies met the inclusion criteria, with 32 reporting prevalence and 18 information on functional outcomes. Reported prevalence rates of concomitant TBI varied widely (10-75%) across studies, largely due to inconsistent diagnostic criteria, retrospective data collection, and reliance on incomplete medical records or ICD coding. The identification of mild TBI (mTBI) was particularly problematic, with differing diagnostic criteria employed.. Moderate-severe TBI at the time of SCI significantly increased in-hospital mortality and complications like pneumonia, sepsis, but had minimal effects on rehabilitation trajectory. Functional outcomes, particularly motor and sensory recovery, were generally unaffected by concomitant injury, though subtle cognitive deficits were observed in moderate to severe TBI cases during rehabilitation. Few studies examined outcomes beyond one year post injury. ConclusionOverall, current evidence suggests that concomitant TBI is common in people presenting with an SCI, but its long term functional and cognitive impact remains underexplored. Future research should employ standardised diagnostic criteria, prospective data collection, and long term follow up to clarify the role of concomitant TBI not only in the acute recovery phase, but also chronically.