• Stefano Bargellesi, Luisa Cavasin, Federico Scarponi, Antonio De Tanti, Donatella Bonaiuti, Michelangelo Bartolo, Paolo Boldrini, Anna Estraneo, and Heterotopic Ossification Cross Sectional Survey group (HOCSS) * .
• 1 Physical Medicine and Rehabilitation-Severe Brain Injuries Rehabilitation Unit, Ca' Foncello Hospital, Treviso, Italy.
• Clin Rehabil. 2018 Feb 1; 32 (2): 255-262.

ObjectivesTo report occurrence and identify patient's features and risk factors of heterotopic ossifications in patients with severe acquired brain injury in intensive rehabilitation centres.DesignMulticentre cross-sectional survey.SettingA total of 48 severe acquired brain injury rehabilitation institutes.ParticipantsTraumatic and non-traumatic severe brain-injured patients ( N = 689) in rehabilitation centres on 28 May 2016.Main Outcome MeasureOccurrence of heterotopic ossifications diagnosed by standard radiological and/or sonographic evaluation on the basis of clinical suspicion.ResultsHeterotopic 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.ConclusionOccurrence 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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