and Rehabilitation for medical evaluation and rehabilitation treat-ment.Interventions: The variables were collected by following a proto-col designed for the study.Main Outcome Measures: Visual analog scale (VAS) for theintensity of neck pain, the Goldberg Depression and Anxiety Scale,and the Northwick Park Neck Pain Questionnaire (NPH) for cervi-cal column functionality at initial evaluation and 6 months later.Results: Factors related with VAS 6 months after the whiplashinjury were the following: women; age; previous neck pain; previ-ous dorsal pain; previous drug taking, including antidepressivesand/or sedatives; housewives; pensioners; students; the presence ofheadache or dizziness at initial evaluation; and VAS, GoldbergDepression and Anxiety Scale, and NPH scores at initial evaluation.In multivaried analysis, it had been found that the variables that hadinfluence on VAS 6 months after the whiplash injury were statisti-cally significant for women, age, previous dorsal pain, the presenceof dizziness, and VAS and NPH scores at initial evaluation.Conclusions: Our findings indicate that factors that allow us toidentify patients at risk for poor recovery are gender, age, previousdorsal pain, and dizziness, and initial evaluation of neck pain withVAS and cervical column functionality with NPH.

Poster 43Enoxaparin-induced Skin Necrosis in a Patient WithPolytrauma: A Case Report.Meilani H. Mapa, MD (Memorial Hermann Rehabilita-tion Hospital, Houston, TX, United States); Benjamin T.Mega, MD, Matthew R. Peterson.

Disclosures: M. H. Mapa, none.Patients or Programs: A 55-year-old man with surgical repairsof left femur and bilateral radius fractures after a fall.Program Description: On day 1 after surgery, Enoxaparin 30mg, subcutaneous, every 12 hours was started for deep venousthrombosis (DVT) prophylaxis (white blood cell [WBC] count, 9.6;PLT, 331). On day 6 after surgery, the patient reported burning painin the right lower quadrant (RLQ) after receiving enoxaparin injec-tion. On day 7, a 4-cm ecchymosis was noted in the RLQ. Enoxa-parin was discontinued. On day 8, the RLQ lesion progressed to a4-cm area of necrosis, with significant erythema streaking across theabdomen. Two other lesions were seen in his left and RLQ. Thepatient also had low-grade fever (t-max, 100.0; WBC count, 12.4;PLT, 535; eosinophils, 5.8) The patient was given vancomycin forpresumed cellulitis and famotidine-diphenhydramine for allergicreaction. RLQ ultrasound showed edema of the superficial tissueswithout fluid collection. On day 9, serology was normal (WBCcount, 10.4; PLT, 425; eosinophils, 3.7). Fondaparinux 2.5 mgsubcutaneous daily was started for DVT prophylaxis. On day 10, thepatient tested positive for antiheparin antibody. Examination of theRLQ revealed the area of necrosis but with less erythema. This lesionwas treated with bacitracin. On day 13, the antibiotic was switchedto clindamycin 300 mg 3 times a day. On day 15, the patient wasdischarged home with clindamycin to complete in 7 days andfondaparinux to complete in 3 months of treatment.Setting: Rehabilitation unit, level 1 trauma center.Discussion: LMWHs are commonly administered in rehabilita-tion units for DVT prophylaxis. The scientific literature suggeststhat, although enoxaparin-induced skin necrosis is uncommon, it

can be fatal. This case illustrates the need for awareness of thispotential complication, early detection, and intervention.Conclusions: Enoxaparin injection sites should be monitored fordevelopment of lesions. With early detection and analysis of theseskin lesions, appropriate management may prevent the progressionto potentially serious complications.

Poster 44Interrater Reliability of the Neurological ImpairmentScale (NIS): A Standard Impairment Set forNeurorehabilitation Populations.Aung Thu, FRCP (Northwick Park Hospital, Middlesex,United Kingdom); Rebecca J. Casey, BA, MSc, Lynne F.Turner-Stokes, DM FRCP, Heather Williams, MSc.

Disclosures: A. Thu, NIHR Service Delivery Organisation grant0001833.Objective: To examine interrater reliability of the NeurologicalImpairment Scale (NIS) and to compare ratings between the medicaland multidisciplinary team.Design: An analysis of routinely collected data from a prospectivecohort collected over 15 months, from September 1, 2009 toNovember 30, 2010. Interrater agreement was compared between 2doctors scoring independently from medical assessment (n�47)within 48 hours of admission. Medical scores were compared withmultidisciplinary team scores (n�82) within 10 days of admission.Score totals were compared by using intraclass correlation (ICC),and item-by-item agreement was tested by using linear-weightedCohen � coefficients.Setting: A tertiary specialist inpatient neurologic rehabilitationunit.Participants: 82 patients (mean [standard deviation] age,42�14.6 years); 35 had stroke (43%), 35 other acquired braininjury (43%), 12 spinal cord and/or peripheral neurologic or otherconditions (15%).Interventions: N/A.Main Outcome Measures: The NIS forms part of the standardminimum data set for the U.K. Functional Assessment Measure(U.K. FIM�FAM). It records severity functional impairment (rated0-4) across 13 domains mapped onto the International Classifica-tion of Functioning (ICF). The score range is 0-50.Results: Interrater reliability: ICC for the total NIS score was 0.95(95% confidence interval [CI], 0.91-0.97); P�.001. Item-by-itemagreement ranged from �, 0.58-0.94. Comparison between medicaland team ratings: ICC for total NIS score was 0.92 (95% CI,0.88-0.95); P�.001. Item-by-item agreement was good overall (�,0.69) with strong agreement for “motor,” “sensory,” “perception,”“speech,” “cognitive,” and “mood” items (�, 0.57-0.81), but weakeragreement was seen for “tone,” “behavior,” “pain,” and “fatigue” (�,0.13-0.44).Conclusions: The NIS showed good interrater reliability be-tween 2 doctors rating on the same assessment. The differencesbetween medical and team ratings were expected due to the longertime period allowed for team observation and possibly also thedifferent approaches to clinical evaluation by different professionalgroups. Total scores, nevertheless, were close enough for eithermethod to be used in conjunction with FIM�FAM rating.

S191PM&R Vol. 3, Iss. 10S1, 2011