Journal:Archives of Physical Medicine and Rehabilitation
Year, Volume, Issue, Page(s):11, 92, 5, 721-730
Study identified factors that predict acute hospital discharge disposition after moderate to severe traumatic brain injury (TBI). Secondary analysis was conducted of archival data for adults hospitalized with moderate to severe TBI included in 3 large existing datasets: (1) Centers for Disease Control and Prevention Central Nervous System Injury Surveillance database; (2) the National Trauma Data Bank; and (3) the National Study on the Costs and Outcomes of Trauma. The main outcome was discharge disposition from acute hospitalization to 1 of 3 postacute settings: home, inpatient rehabilitation, or subacute settings, including nursing homes and similar facilities. Analysis revealed that the Glasgow Coma Scale (GCS) score and length of acute hospital length of stay (LOS) accounted for 35 to 44 percent of the variance in discharges to home versus not home, while age and sex added from 5 to 8 percent, and race/ethnicity and hospitalization payment source added another 2 to 5 percent. When predicting discharge to rehabilitation versus subacute care for those not going home, GCS and LOS accounted for 2 to 4 percent of the variance, while age and sex added 7 to 31 percent, and race/ethnicity and payment source added 4 to 5 percent. Across the datasets, longer LOS, older age, and white race increased the likelihood of not being discharged home; the most consistent predictor of discharge to rehabilitation was younger age. The decision to discharge to home a person with moderate to severe TBI appears to be based primarily on severity-related factors, while the decision to discharge to rehabilitation rather than to subacute care appears to reflect sociobiological and socioeconomic factors.