Malec James F, Mandrekar Jayawant N, Brown Allen W, Moessner Anne M
Rehabilitation Hospital of Indiana, Indianapolis, IN 46254, USA.
Brain Inj. 2009 Jan;23(1):22-9. doi: 10.1080/02699050802590320.
To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI).
A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions.
Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases.
Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.
评估人口统计学因素、创伤后遗忘症（PTA）以及能力受限的标准化测量指标与中重度创伤性脑损伤（TBI）急性住院治疗后下一护理级别的临床决策之间的关联。
一名TBI临床护士专家记录了212名个体的PTA情况，并根据梅奥-波特兰适应性量表（MPAI-4）的能力和适应指数对159人进行了评分，以便与临床决策进行比较。
多因素逻辑回归分析显示，在92.7%的样本中，MPAI-4能力指数的独立评分和PTA与住院康复与出院回家的临床决策相关；仅能力指数评分在92.2%的病例中与该决策相关。65岁以上是与入住专业护理机构出院相关的唯一变量，在64%的病例中正确预测了这一决策。
使用能力受限的标准化测量指标似乎可行，可为推荐住院康复与出院回家提供支持性文件，并可能提高决策的一致性。尽管年龄是入住专业护理机构出院决策的一个重要因素，但这一决策似乎很复杂，值得进一步研究。
