Citation

Cuthbert JP, Corrigan JD, Harrison-Felix C, Coronado V, Dijkers MP, Heinemann AW, Whiteneck GG. Arch. Phys. Med. Rehabil. 2011; 92(5): 721-730.e3.

Affiliation

Research Department, Craig Hospital, 3425 S Clarkson St., Englewood CO 80113, USA. JCuthbert@Craighospital.org

Copyright

(Copyright © 2011, Elsevier Publishing)

DOI

10.1016/j.apmr.2010.12.023

PMID

21530719

Abstract

OBJECTIVE: To identify factors predicting acute hospital discharge disposition after moderate to severe traumatic brain injury (TBI).

DESIGN: Secondary analysis of existing datasets. SETTING: Acute care hospitals. PARTICIPANTS: Adults hospitalized with moderate to severe TBI included in 3 large sets of archival data: (1) Centers for Disease Control and Prevention Central Nervous System Injury Surveillance database (n=15,646); (2) the National Trauma Data Bank (n=52,012); and (3) the National Study on the Costs and Outcomes of Trauma (n=1286). INTERVENTIONS: None. MAIN OUTCOME MEASURE: Discharge disposition from acute hospitalization to 1 of 3 postacute settings: (1) home, (2) inpatient rehabilitation, or (3) subacute settings, including nursing homes and similar facilities.

RESULTS: The Glasgow Coma Scale (GCS) score and length of acute hospital length of stay (LOS) accounted for 35% to 44% of the variance in discharges to home versus not home, while age and sex added from 5% to 8%, and race/ethnicity and hospitalization payment source added another 2% to 5%. When predicting discharge to rehabilitation versus subacute care for those not going home, GCS and LOS accounted for 2% to 4% of the variance, while age and sex added 7% to 31%, and race/ethnicity and payment source added 4% to 5%. Across the datasets, longer LOS, older age, and white race increased the likelihood of not being discharged home; the most consistent predictor of discharge to rehabilitation was younger age.

CONCLUSIONS: The decision to discharge to home a person with moderate to severe TBI appears to be based primarily on severity-related factors. In contrast, the decision to discharge to rehabilitation rather than to subacute care appears to reflect sociobiologic and socioeconomic factors; however, generalizability of these results is limited by the restricted range of potentially important variables available for analysis.

Language: en