Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Drs Totman, Goldstein, Giacino, Bodien, Ryan, Schneider, and Zafonte); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Drs Totman, Goldstein, Giacino, Bodien, Ryan, Schneider, and Zafonte); Mary Free Bed Rehabilitation Hospital, Grand Rapids, Michigan (Dr Lamm); Massachusetts General Hospital, Boston, Massachusetts (Drs Giacino, Ryan, and Zafonte); Shriners Hospitals for Children, Boston, Massachusetts (Dr Ryan); and Brigham and Women's Hospital, Boston, Massachusetts (Dr Zafonte).
J Head Trauma Rehabil. 2023;38(3):E186-E194. doi: 10.1097/HTR.0000000000000814. Epub 2022 Oct 14.
The goal of this study is to describe national trends in inpatient rehabilitation facility (IRF) discharges for the most severely disabled cohort of patients with traumatic brain injury (TBI).
Data from the Uniform Data System for Medical Rehabilitation for patients discharged from an IRF between January 1, 2002, and December 31, 2017, with a diagnosis of TBI and an admission Functional Independence Measure of 18, the lowest possible score, were obtained and analyzed.
Of the 252 112 patients with TBI discharged during the study period, 10 098 met the study criteria. From 2002 to 2017, the number of patients with an IRF admission Functional Independence Measure of 18 following TBI discharged from IRFs annually decreased from 649 to 488, modeled by a negative regression (coefficient = -2.97; P = .001), and the mean age (SD) increased from 43.0 (21.0) to 53.7 (21.3) years (coefficient = 0.70; P < .001). During the study period, the number of patients with the most severe disability on admission to IRF who were discharged annually as a proportion of total patients with TBI decreased from 5.5% to 2.5% (odds ratio = 0.95; P < .001) and their mean length of stay decreased from 41.5 (36.2) to 29.3 (24.9) days (coefficient = -0.83; P < .001].
The number and proportion of patients with the most severe disability on IRF admission following TBI who are discharged from IRFs is decreasing over time. This may represent a combination of primary prevention, early mortality due to withdrawal of life-sustaining treatment, alternative discharge dispositions, or changes in admitting and reimbursement practices. Furthermore, there has been a decrease in the duration of IRF level care for these individuals, which could ultimately lead to poorer functional outcomes, particularly given the importance of specialized rehabilitative care in this population.
本研究旨在描述创伤性脑损伤（TBI）患者中最严重残疾队列在住院康复设施（IRF）中的出院国家趋势。
从 2002 年 1 月 1 日至 2017 年 12 月 31 日期间，从接受过 IRF 治疗且诊断为 TBI 且入院功能独立性测量（FIM）为 18（最低得分）的患者的统一数据系统中获得并分析了数据。
在研究期间，有 252112 例 TBI 患者出院，其中 10098 例符合研究标准。从 2002 年到 2017 年，每年从 IRF 出院的 TBI 患者中 IRF 入院 FIM 为 18 的人数从 649 人减少到 488 人，模型呈负回归（系数=-2.97；P=0.001），平均年龄（标准差）从 43.0（21.0）岁增加到 53.7（21.3）岁（系数=0.70；P<.001）。在研究期间，每年以 TBI 患者总数的比例出院的 IRF 入院时最严重残疾患者的数量从 5.5%减少到 2.5%（优势比=0.95；P<.001），其平均住院时间从 41.5（36.2）天减少到 29.3（24.9）天（系数=-0.83；P<.001）。
随着时间的推移，从 TBI 后 IRF 入院时最严重残疾的患者数量和比例出院的人数正在减少。这可能代表初级预防、因放弃维持生命的治疗而导致的早期死亡、替代出院处置或入院和报销实践的变化的综合作用。此外，这些患者的 IRF 护理时间有所减少，这可能最终导致功能结果更差，特别是考虑到在该人群中专门康复护理的重要性。
