Affiliations: [a]
Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| [b]
Department of Surgery, Division of Acute Care Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| [c]
Department of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA
Correspondence:
[*]
Address for correspondence: Eric Ley, Department of Surgery, Division of Trauma and Critical Care, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA. Tel.: +310 423 3544; Fax: +310 423 5454; E-mail: [email protected].
Abstract: OBJECTIVE: To determine factors associated with response to inpatient rehabilitation treatment among TBI patients. SETTING: Inpatient rehabilitation service at a Level I trauma center. PARTICIPANTS: Moderate-severe TBI patients ages ≥ 18years old admitted between January 1, 2002 and December 31, 2012. MAIN MEASURES: Response to inpatient rehabilitation, measured by the Functional Independence Measure (FIM) score. DESIGN: Retrospective cohort study. RESULTS: Of 1,984 patients treated for TBI, 184 (10.8%) underwent inpatient rehabilitation. The largest proportion of patients improved in mobility (98.9%), followed by self-care (93.7%), communication/social cognition (84.0%), and sphincter control (65.7%). Of these, 99 (53.8%) improved by 2 or more levels of functional independence and were considered rehabilitation responders. Responders were younger (53.1 years vs. 63.8, p < 0.01), had longer average rehabilitation stays (15.4 days vs. 12.2, p < 0.01), and were less likely to have an admission SBP <100 mmHg (7.1% vs. 17.1%, p = 0.01). On multivariate analysis, normotension at admission (AOR 0.06, p = 0.01) and longer rehabilitation LOS (AOR 1.11, p < 0.01) were associated with a response to inpatient rehabilitation. CONCLUSION: Of the TBI patients who qualified for same-center inpatient rehabilitation, approximately half responded to treatment. Longer rehabilitation time and normotension at admission predicted response to rehabilitation. Further efforts are necessary to identify and optimize TBI patients for inpatient rehabilitation.
