Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation

Details

• Alternative Title:
  J Head Trauma Rehabil
• Personal Author:
  Totman, Alissa A. ; Lamm, Adam G. ; Goldstein, Richard ; Giacino, Joseph T. ; Bodien, Yelena G. ; Ryan, Colleen M. ; Schneider, Jeffrey C. ; Zafonte, Ross
• Description:
  Objective:
  
  The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI).
  
  Methods:
  
  Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002 and December 31, 2017 with a diagnosis of TBI and an admission Functional Independence Measure (FIM) of 18, the lowest possible score, was obtained and analyzed.
  
  Results:
  
  Of the 252,112 patients with TBI discharged during the study period, 10,098 met the study criteria. From 2002 to 2017 the number of patients with an IRF admission FIM of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression [coefficient = −2.97; p = 0.001] and the mean age (sd) increased from 43.0 (21.0) to 53.7 (21.3) years [coefficient = 0.70; p < 0.001]. During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% [odds ratio = 0.95; p < 0.001] and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days [coefficient = −0.83; p <0.001].
  
  Conclusion:
  
  The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.
  
  
• Subjects:
  Brain Injuries, Traumatic Disabled Persons Humans Inpatients Length Of Stay Patient Discharge Recovery Of Function Rehabilitation Centers Retrospective Studies Treatment Outcome
• Source:
  J Head Trauma Rehabil. 38(3):E186-E194
• Pubmed ID:
  36730991
• Pubmed Central ID:
  PMC10102246
• Document Type:
  Journal Article
• Funding:
  90DPBU0001/ACL/ACL HHSUnited States/ ; 90DPCP0008/ACL/ACL HHSUnited States/ ; R01 AI134857/AI/NIAID NIH HHSUnited States/ ; 90DP0039/ACL/ACL HHSUnited States/ ; UG3 NS117844/NS/NINDS NIH HHSUnited States/ ; U48 DP000039/DP/NCCDPHP CDC HHSUnited States/ ; U01 NS086090/NS/NINDS NIH HHSUnited States/ ; UH3 NS095554/NS/NINDS NIH HHSUnited States/
• Volume:
  38
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:552a590387769ab570b433f4fdb48b08f14a18423e674c2257ff173d0e5d7c92
• Download URL:
  https://stacks.cdc.gov/view/cdc/140146/cdc_140146_DS1.pdf
• File Type:
  [PDF - 323.07 KB ]