Description of the moderate brain injured patient and predictors of discharge to rehabilitation

Abstract

This retrospective, descriptive study characterized moderate traumatic brain injured patients between the ages of 18 to 64 years that were treated at level I and level II trauma centers within the United States and the predictors of discharge to rehabilitation after acute care using data reported in the National Trauma Data Bank (NTDB®). A literature review described the issues related to traumatic brain injury, examined conflicting results related to post-acute care discharge, and supported the need for further study of the moderate traumatic brain injured patient. The 2010 National Sample Project (NSP), part of the NTDB®, provided access to cross- sectional data with which to describe the moderate TBI patient and to explore the demographic, clinical, and financial predictors of discharge to rehabilitation within a sample of TBI patients. Multivariate logistic regression models revealed that demographic (age and region), clinical (injury severity score, Glasgow Coma score, and Abbreviated Injury score of the head), and financial (primary payment source and length of stay) characteristics influenced the likelihood of being discharged to rehabilitation. Increased age, increased severity, Medicare, longer length of stay (LOS), and trauma center locations in the Midwest and Northeast all increased likelihood of discharge to rehabilitation. Being younger, receiving acute treatment in the South, and self-pay all showed decreased likelihood of discharge to rehabilitation. The decision to discharge a person with a moderate TBI from acute care to rehabilitation appears to be based on factors other than just clinical need. More equitable access to post-acute rehabilitation services for moderate TBI patients is needed because of the risk for long-term disabilities and the potential to return to productive lives with treatment.