Predictors of Extended Rehabilitation Length of Stay After Traumatic Brain Injury

doi:10.1016/j.apmr.2010.07.010

Archives of Physical Medicine and Rehabilitation

Volume 91, Issue 10, October 2010, Pages 1495-1504

https://doi.org/10.1016/j.apmr.2010.07.010 Get rights and content

Abstract

Arango-Lasprilla JC, Ketchum JM, Cifu D, Hammond F, Castillo C, Nicholls E, Watanabe T, Lequerica A, Deng X. Predictors of extended rehabilitation length of stay after traumatic brain injury.

Objective

To develop a prediction rule for acutely identifying patients at risk for extended rehabilitation length of stay (LOS) after traumatic brain injury (TBI) by using demographic and injury characteristics.

Design

Retrospective cohort study.

Setting

Traumatic Brain Injury Model Systems.

Participants

Sample of TBI survivors (N=7284) with injuries occurring between 1999 and 2009.

Interventions

Not applicable.

Main Outcome Measures

Extended rehabilitation LOS defined as 67 days or longer.

Results

A multivariable model was built containing FIM motor and cognitive scores at admission, preinjury level of education, cause of injury, punctate/petechial hemorrhage, acute-care LOS, and primary payor source. The model had good calibration, excellent discrimination (area under the receiver operating characteristic curve = .875), and validated well. Based on this model, a formula for determining the probability of extended rehabilitation LOS and a prediction rule that classifies patients with predicted probabilities greater than 4.9% as at risk for extended rehabilitation LOS were developed.

Conclusions

The current predictor model for TBI survivors who require extended inpatient rehabilitation may allow for enhanced rehabilitation team planning, improved patient and family education, and better use of health care resources. Cross-validation of this model with other TBI populations is recommended.

Section snippets

Participants

Participants were enrolled in the national database of the National Institute on Disability and Rehabilitation Research–funded TBIMS program, a multicenter longitudinal study of TBI outcomes. Each TBIMS-funded center received approval by its individual institutional review board. Inclusion in the TBIMS national database requires the patient to meet the following criteria: (1) at least 16 years old at the time of injury; (2) arrived at a TBIMS acute-care hospital within 72 hours of injury; (3)

Description of the Sample

Demographic and injury characteristics of the sample of participants included in the model-building and validation stages are listed in table 1. For the entire sample, average age of participants was 39.6±18.7y, and participants were primarily men (73%), white (70%), employed at injury (64%), and had at least a high school level of education at injury (71%). Injuries were predominately vehicular/sport related (58%) and classified as moderate or severe (60%). Those classified as having an

Discussion

The purpose of the present study was to build a model for predicting extended rehabilitation LOS for TBI survivors early after injury by using demographic and injury characteristics. Approximately 5.1% of the model-building sample were defined as having an extended rehabilitation LOS. Model-building strategies using 75% of the sample resulted in a model containing punctate/petechial hemorrhage, cause of injury, FIM motor and cognitive scores at admission, acute-care LOS, primary payor source,

Conclusions

The purpose of the present study was to build a model for acutely predicting extended rehabilitation LOS for TBI survivors by using demographic and injury characteristics and to create an easy-to-use prediction rule. A multivariable model for prediction was built by using FIM motor and cognitive scores at admission, acute-care LOS, level of education at injury, cause of injury, punctate/petechial hemorrhage, and primary payor source as predictor variables. The model had good calibration,

Acknowledgments

We thank Brian J. Bush for contributions in the area of Web-site development.

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However, in addition to a decade-long period without data collection, several hospitals do not contribute to the audit [42]. Consequently, it was not possible to stratify cases by injury severity, extracranial injury severity, neurological status, or pre-injury comorbidity, which are important determinants of survival and resource utilisation following head and brain injury [1,43–45]. This is therefore a significant limitation to our study.
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Although initial mortality following TBI is high, survivors of the first month post-injury can achieve comparable long-term survival to HI. However, this is associated with, and may require, increased utilisation of hospital services in the TBI group.
Variations in Inpatient Rehabilitation Functional Outcomes Across Centers in the Traumatic Brain Injury Model Systems Study and the Influence of Demographics and Injury Severity on Patient Outcomes
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Patients with TBI who have a lengthier inpatient rehabilitation course (LOS) have been shown to make greater gains on the motor and cognitive components of the FIM by the time of discharge.24,25 Greater severity of TBI is associated with longer LOS.17 Contrary to the previously mentioned studies, 2 studies found that prolonged LOS has been negatively associated with discharge functional status as measured by the FIM and Rancho Los Amigos scale.26,27
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Functional outcomes of patients with TBI.
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TBI Model Systems centers.
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None.
Glasgow Outcome Scale-Extended (GOS-E).
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: Supported by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (grant nos. H133A070036, H133A21943-16, and H133A07003).

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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Original articlePredictors of Extended Rehabilitation Length of Stay After Traumatic Brain Injury

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Description of the Sample

Discussion

Conclusions

Acknowledgments

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Head injuries: cost and consequences

J Head Trauma Rehabil

Outcomes and cost of acute treatment of traumatic brain injury

J Trauma

Charges and length of stay for acute and inpatient rehabilitation treatment of traumatic brain injury

Brain Inj

Original article
Predictors of Extended Rehabilitation Length of Stay After Traumatic Brain Injury