Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients

Muakkassa, Farid; Marley, Robert; Billue, Katherine; Marley, Mackenzie; Horattas, Sophia; Yetmar, Zachary A; Salvator, Ann; Hayek, Anthony

doi:10.1097/phm.0000000000000453

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…The author have been observed that there is negative correlation of LOSa with FIMd and Gain (r=-0.507, p=0.00 and r=-0.402, p=0.004), respectively. Similarly, Muakkassa et al [14] published that an increased risk of low FIM (OR, 2.21; 95% CI, 1.41-3.45; P=0.001) was observed with an increased ratio of Hospital length of Stay (HLOS/RLOS) after adjusting for injury severity score. FIMa is positively correlated with FIMd but negatively correlated to gain.…”

Section: Resultsmentioning

confidence: 84%

Functional Outcomes of Patients with Acute Spinal Cord Injury

Nadukkandiyi¹,

Hamawi²,

Yazeedi³

et al. 2017

Int J Neurorehabilitation Eng

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The purpose of this study was to identify relationships between age, length of stay, the American Spinal Injury Association classification (ASIA) with total functional gain during inpatient rehabilitation for patients with Spinal Cord Injury (SCI) with functional independence and rehabilitation outcomes of traumatic spinal cord patients. The data were obtained for 49 patients with traumatic spinal cord lesions admitted to the neuro physical therapy unit from 2006 to 2008. The mean age was 33 ± 10.63 years.Study design: Retrospective observational study. The patient's characteristics and outcomes were analysed and compared according to the severity of traumatic spinal cord injuries (SCI) and its appearance according to vertebral level correlations of SCI with co-morbidities was analysed. The Functional Independent measure scores of patient at admission (FIMa) on were compared to Functional Independent Measure scores recorded at discharge (FIMd) to get the total gain for each patient. Patients were grouped according to age, level of neurological injury, length of stay to compare with the total gain. The Length of stay was also compared with the American Spinal Injury Association classification (ASIA) at discharge. The author had been observed that there is negative correlation of LOSa with FIMd and Gain (r=-0.507, p=0.00 and r=-0.402, p=0.004), respectively. FIMa is positively correlated with FIMd but negatively correlated to Gain. FIMd is positively related with Gain. The Mean LOSa and LOSr are 44.80 days and 174.37 days, respectively. The Mean FIMa and FIMd are 53.22% and 75.73%, respectively. It revealed that, a significant improvement in FIM at the time of discharge in SCI patients. The differences were found in the extent of functional improvement between subgroups of patients with different levels and extents of lesions. Regarding the outcome of Functional Independent measure better observed in incomplete cervical spinal cord injuries and complete thoracic spinal cord level injuries. Interestingly, independence in bowel management, independent mobility and locomotion were only attained by patients with incomplete lesions. This study provides insight into the functional outcomes of a group of inpatients with traumatic spinal cord injury. More research is needed to determine the specialized rehabilitation program for these patients.

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Section: Resultsmentioning

confidence: 84%

Functional Outcomes of Patients with Acute Spinal Cord Injury

Nadukkandiyi¹,

Hamawi²,

Yazeedi³

et al. 2017

Int J Neurorehabilitation Eng

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“…Frailty due to aging may have also impacted recovery and increased the risk of complications in our population, as frailty has been shown to negatively impact health outcomes by 2-5 times (15,36,37,39). Comprehensive geriatric assessment and tailored treatment approaches are essential for optimizing outcomes in older adult trauma patients given they already have delays in reaching care, stay longer in hospitals following injuries, and are more likely to die compared to younger adults (54)(55)(56).…”

Section: Discussionmentioning

confidence: 99%

The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.

Shewiyo,

Njau,

de Oliveira

et al. 2024

Preprint

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Background: The number of older adults (>60 years) is projected to double by 2050 in Sub-Saharan Africa (SSA). This demographic shift has increased the number of traumatic injuries in this population with 1 in 10 trauma patients in Tanzania being an older adult. Geriatric specialization is all but absent in many LMICs healthcare systems including Tanzania. To inform interventions to optimize healthcare among this unique population, this study aimed to describe the characteristics of injuries and in-hospital complications among older adult trauma patients treated at Kilimanjaro Christian Medical Centre (KCMC), a tertiary hospital in Northern Tanzania.Methods: This was a cross-sectional secondary analysis using an adult injury registry from the KCMC in Tanzania. KCMC is a tertiary hospital located in the Kilimanjaro region serving >15 million people. This study included all adult trauma patients (>18 years) from the trauma registry from 2020-2024. We described the injured older adult trauma patients’ socio-demographics, clinical characteristics, and injury patterns compared to younger patients. The main outcomes were length of stay (LOS) and in-hospital mortality. Ethics approval for the study was obtained from the following ethics boards: KCMC, the National Institute for Medical Research in Tanzania, and Duke University. Results: Our study included 3,296 adult injured patients with (13.3%) being older adults (>60 years). The median age of the sample was 34 years (IQR: 26-48) with older adults having a median age of 70 (IQR: 64-79). There were significant differences in all patient characteristics and in-hospital outcomes between older and younger injured adults. Older adult injured patients had higher female representativeness (43%) than younger patients (16%) (p<0.001). Older adult patients took an average of 4 hours longer to reach care following injury compared to younger adults (p<0.001). The majority of older adults had fall mechanisms (56%) while the majority of younger adults had road traffic crash mechanisms (67%) (p<0.001). The majority of older adults had mild severity of injury (86%) than younger adults (27%) (p<0.001). However, the majority of older adult patients required hospitalization (91%) or surgery (66%) following injury than younger adults (85%, 58% respectively) (p=0.002). Older adult injury patients had higher proportions of NCDs: diabetes (12%) and hypertension (26%) compared to younger patients (1% and 2% respectively) (p<0.001). Lastly, older adults spent on average 4 days more at the hospital than younger adults with higher proportions of in-hospital deaths (9%) than the younger adults (4%) (p<0.001). Conclusion: Our study demonstrates the significant differences between the injured older adult patients and the younger adult patients at KCMC. Specifically, older adults had a higher proportion of comorbidities; took longer times to reach care; required hospitalization and surgeries from minor mechanisms (falls); and had twice as long hospital stays and in-hospital deaths. Our findings highlight the differences in care required for older adult trauma patients and provide evidence to support the creation and implementation of older adult-specific interventions to improve outcomes and mobilize healthcare resources for this growing population following trauma.

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“…Um doente que se mantém durante mais tempo em meio hospitalar encontra-se necessariamente fora da sua rotina, torna-se mais sedentário e recebe menor estímulo à função e autonomia. 22,23 Estes achados parecem ser independentes do grau de complexidade ou severidade do diagnóstico de entrada e da sua progressão clínica. 22,23 Esta é também a principal justificação para a crescente necessidade de incluir no plano de alta hospitalar a intervenção dos profissionais de reabilitação nestes doentes, o que se refletiria de forma positiva na sua independência e na redução de complicações secundárias, tais como quedas ou delirium.…”

Section: Discussionunclassified

“…22,23 Estes achados parecem ser independentes do grau de complexidade ou severidade do diagnóstico de entrada e da sua progressão clínica. 22,23 Esta é também a principal justificação para a crescente necessidade de incluir no plano de alta hospitalar a intervenção dos profissionais de reabilitação nestes doentes, o que se refletiria de forma positiva na sua independência e na redução de complicações secundárias, tais como quedas ou delirium. 24,25 A prorrogação de uma alta hospitalar tem um impacto negativo não só no utente -num momento de particular vulnerabilidade e exposição a potenciais reinfeções e agravamento da sua condição de saúde e independência -mas também na gestão hospitalar, tanto logística como economicamente.…”

Section: Discussionunclassified

Fatores de Risco para Alta Prorrogada por Motivos Sociais: Um Estudo Retrospectivo

Martins

Carvalho²,

Martins³

et al. 2023

Acta Med Port

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Introdução: Os hospitais deparam-se com uma percentagem das suas camas ocupadas por doentes cuja alta hospitalar está limitada não pela alta clínica, mas por outros fatores. Cria-se a necessidade da identificação precoce dos indivíduos que estão em risco de uma alta prorrogada por motivos sociais (internamentos sociais - IS), de forma a reduzir gastos e a acrescentar valor que se traduza em saúde dos utentes. O objetivo deste estudo foi identificar os fatores de risco demográficos e clínicos que condicionam risco de internamento social.Material e Métodos: Foram analisados 582 internamentos referentes a um serviço de Medicina Interna de hospital terciário nos anos de 2018 e 2019, e consideradas as características demográficas e comorbidades clínicas dos doentes. Foi feita uma regressão logística binominal ajustada ao sexo, idade e internamento clínico prolongado, para identificação de potenciais fatores de risco associados a alta prorrogada.Resultados: Foram incluídos neste estudo um total de 473 doentes admitido no serviço no período de dois anos em estudo. Noventa e quatro (19%) doentes tiveram a sua alta prorrogada, dos quais 64 (68%) eram do sexo feminino. As principais características estatisticamente significativas associadas a maior risco de prorrogação da alta foram o sexo feminino (OR 2,84, 95% IC 1,65 – 4,90, p-value < 0,05), o internamento clínico prolongado (OR 2,64, 95% IC 1,60 – 4,937, p-value < 0,05) e a diabetes mellitus (OR 1,87, 95% IC 1,08 – 3,23, p-value < 0,05); para além destes, a presença de insuficiência cardíaca (OR 0,52, 95% IC 0,27 – 0,99, p-value < 0,05) e de doença renal crónica (OR 0,34, 95% IC 0,14 – 0,86, p-value < 0,05) associaram-se a um risco inferior de prorrogação de alta.Conclusão: O sexo feminino, os internamentos clínicos prolongados e diabetes mellitus associaram-se a um maior risco de internamento social, enquanto a insuficiência cardíaca e a doença renal crónica se associaram a um risco inferior de IS. Estes achados servem de base de construção para um futuro estudo multicêntrico para criação de uma regra de predição clínica para estratificação do risco de internamento social na população portuguesa.

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Effect of Hospital Length of Stay on Functional Independence Measure Score in Trauma Patients

Cited by 6 publications

References 32 publications

Functional Outcomes of Patients with Acute Spinal Cord Injury

Functional Outcomes of Patients with Acute Spinal Cord Injury

The older the injured, the worse the outcomes: A comparison of injury patterns and in-hospital outcomes between younger and older adult trauma patients at a tertiary hospital in Northern Tanzania.

Fatores de Risco para Alta Prorrogada por Motivos Sociais: Um Estudo Retrospectivo

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