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Abstract
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OBJECTIVES: To understand how health status preceding traumatic brain injury (TBI) affects relative functional gain after inpatient rehabilitation using a data mining approach.
DESIGN: Population-based, sex-stratified, retrospective cohort study using health administrative data from Ontario, Canada (39% of the Canadian population).
SETTING: Inpatient rehabilitation.
PARTICIPANTS: Patients 14 years or older (N=5,802; 63.4% males) admitted to inpatient rehabilitation within one-year of a TBI-related acute care discharge between April 1, 2008 and March 31, 2015.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Relative functional gain (RFG) in percent, calculated as [(Discharge FIM-Admission FIM)/(126-Admission FIM) x 100]. Health status prior to TBI was identified and internally validated using a data mining approach that categorized all International Classification of Diseases Version 10 codes for each patient.
RESULTS: The average RFG among males was 52.8±27.6% and among females, 51.6±27.1%. Sex-specific Bonferroni adjusted multivariable linear regressions identified 10 factors of pre-injury health status related to neurology, emergency medicine, cardiology, psychiatry, geriatrics, and gastroenterology that were significantly associated with reduced RFG in FIM for males. Only one pre-injury health status category, geriatrics, was significantly associated with RFG in female patients.
CONCLUSIONS: Comorbid health conditions present up to five years preceding the TBI event were significantly associated with RFG. These findings should be considered when planning and executing interventions to maximize functional gain and to support an interdisciplinary approach. Best practices guidelines and clinical interventions for older males and females with TBI should be developed to account given the increasingly aging TBI population.
Language: en |