Short Tilte:brain injury: A multicenter analysis
Year, Volume, Issue, Page(s):99, 80, , 85-90
Objective: To investigate incidence and etiology of rehospitalizations at 1,2, and 3 years after traumatic brain injury. Design: Descriptive statistics were computed in a prospective study of etiology and incidence of rehospitalization at years 1, 2, and 3 postinjury. Analysis of variance (ANOVA) and x2 were used to identify factors relating to rehospitalization; factors included length of stay, admission and discharge functional status, payer source, medical complications, injury
severity, and demographics. Setting: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems. In each setting, the continuum of care includes emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services. Participants: Six hundred sixty-five rehabilitation patients admitted to acute care within 24 hours of traumatic brain injury between 1989 and 1996. Main Outcome Measures: Annual incidence and etiology of rehospitalization. Results: The annual incidence of rehospitalization ranged from 20% to 22.5%. Approximately half the rehospitalizations were for elective reasons. The most common reason for rehospitalization was for orthopedic or reconstructive surgery, followed by infectious disorders and general health maintenance. After the first year, the incidence of readmissions for seizures and psychiatric difficulties increased substantially. ANOVA and x2 analyses were performed on data from the first year postinjury. No statistically significant associations were noted between incidence and etiology of rehospitalization and: demographics; injury severity; payer source for rehabilitation; From the Department of Physical Medicine and Rehabilitation, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA (Drs. Cifu, Kreutzer, Hsu, Ms. Marwitz, Mr. Seel); the A.I. DuPont Children’s Medical Center, Thomas Jefferson University, Philadelphia, PA (Dr. Miller); the Department of Rehabilitation,
Santa Clara Valley Medical Center (Dr. Englander); the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX (Dr. High); and the Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI. (Dr. Zafonte). Submitted for publication February 26, 1998. Accepted in revised form August 3, 1998. Supported in part by grant H133B80029 from the National Institute on Disability and Rehabilitation Research, United States Department of Education. Data were contributed by Santa Clara Valley Medical Center, Rehabilitation Institute of Michigan, The Institute of Rehabilitation and Research, and the Medical College of Virginia, Virginia Commonwealth University, Richmond, VA. No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.
Reprint requests to David X. Cifu, MD, Deparrment of Physical Medicine and Rehabilitation, Medical College of Virginia, MCV Box 980677, Richmond, VA 23298.0661. D 1999 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation 0003.9993/99/8001-4895$3.00/O concurrent injuries; acute care and rehabilitation length of stays; discharge Functional Assessment Measure; and discharge residence (p > .05). Conclusions: There is a relatively stable but high rate of rehospitalization for at least 3 years after injury. The costs of rehospitalization should be considered when evaluating the long-term consequences of injury. ©1999 by the American Congress