Trauma Center, King Saud Medical City, Riyadh, Saudi Arabia.
Department of Trauma, University Medical Center Utrecht, Utrecht, Netherlands.
PLoS One. 2021 Aug 16;16(8):e0256314. doi: 10.1371/journal.pone.0256314. eCollection 2021.
Early incorporation of rehabilitation services for severe traumatic brain injury (TBI) patients is expected to improve outcomes and quality of life. This study aimed to compare the outcomes regarding the discharge destination and length of hospital stay of selected TBI patients before and after launching an acute intensive trauma rehabilitation (AITR) program at King Saud Medical City. It was a retrospective observational before-and-after study of TBI patients who were selected and received AITR between December 2018 and December 2019. Participants' demographics, mechanisms of injury, baseline characteristics, and outcomes were compared with TBI patients who were selected for rehabilitation care in the pre-AITR period between August 2017 and November 2018. A total of 108 and 111 patients were managed before and after the introduction of the AITR program, respectively. In the pre-AITR period, 63 (58.3%) patients were discharged home, compared to 87 (78.4%) patients after AITR (p = 0.001, chi-squared 10.2). The pre-AITR group's time to discharge from hospital was 52.4 (SD 30.4) days, which improved to 38.7 (SD 23.2) days in the AITR (p < 0.001; 95% CI 6.6-20.9) group. The early integration of AITR significantly reduced the percentage of patients referred to another rehabilitation or long-term facility. We also emphasize the importance of physical medicine and rehabilitation (PM&R) specialists as the coordinators of structured, comprehensive, and holistic rehabilitation programs delivered by the multi-professional team working in an interdisciplinary way. The leadership and coordination of the PM&R physicians are likely to be effective, especially for those with severe disabilities after brain injury.
早期将康复服务纳入严重创伤性脑损伤 (TBI) 患者的治疗中，有望改善其预后和生活质量。本研究旨在比较沙特国王医疗城启动急性强化创伤康复 (AITR) 项目前后，选择并接受 AITR 的 TBI 患者的出院去向和住院时间长短。这是一项回顾性观察性研究，纳入了 2018 年 12 月至 2019 年 12 月间接受 AITR 的 TBI 患者，以及 2017 年 8 月至 2018 年 11 月接受康复护理的 TBI 患者。比较了两组患者的人口统计学、损伤机制、基线特征和结局。在引入 AITR 项目之前的时期，共有 108 名和 111 名患者分别接受了康复治疗。在引入 AITR 项目之前，63 名（58.3%）患者出院回家，而 AITR 后有 87 名（78.4%）患者出院（p = 0.001，卡方检验 10.2）。在引入 AITR 项目之前，患者从医院出院的时间为 52.4（SD 30.4）天，在 AITR 组改善为 38.7（SD 23.2）天（p < 0.001；95%CI 6.6-20.9）。早期整合 AITR 可显著降低转至其他康复或长期机构的患者比例。我们还强调了物理医学和康复（PM&R）专家作为多专业团队的协调者的重要性，该团队以跨学科的方式提供结构化、全面和整体的康复方案。PM&R 医生的领导和协调可能是有效的，尤其是对那些因脑损伤而严重残疾的患者。
