In the Aftermath of Acute Hospitalization for Traumatic Brain Injury: Factors Associated with the Direct Pathway into Specialized Rehabilitation

Abstract

Previous research has demonstrated that early initiation of rehabilitation and direct care pathways improve outcomes for patients with severe traumatic brain injury (TBI). Despite this knowledge, there is a concern that a number of patients are still not included in the direct care pathway. The study aim was to provide an updated overview of discharge to rehabilitation following acute care and identify factors associated with the direct pathway. We analyzed data from the Oslo TBI Registry—Neurosurgery over a five-year period (2015–2019) and included 1724 adults with intracranial injuries. We described the patient population and applied multivariable logistic regression to investigate factors associated with the probability of entering the direct pathway. In total, 289 patients followed the direct pathway. For patients with moderate–severe TBI, the proportion increased from 22% to 35% during the study period. Significant predictors were younger age, low preinjury comorbidities, moderate–severe TBI and disability due to TBI at the time of discharge. In patients aged 18–29 years, 53% followed the direct pathway, in contrast to 10% of patients aged 65–79 years (moderate–severe TBI). This study highlights the need for further emphasis on entering the direct pathway to rehabilitation, particularly for patients aged >64 years.

Referrals to Early Specialized Rehabilitation after Traumatic Brain Injury during the Covid-19 Pandemic

“…When comparing factors predicting the direct pathway to rehabilitation, univariable analysis showed several significant factors, in contrast to the multivariable model. In the multivariable model, strong positive factors in both groups were younger age, pre-injury ASA-score 1–2, severe TBI, severe disability due to TBI upon discharge, in line with a previous study ( 14 ). We cannot fully explain the variation regarding male sex, but contributing factors may be that in younger TBI patients, males are over-represented and males more often need emergency neurosurgery ( 29 , 30 ).…”

“…The current study did not find a decline in the direct pathway to specialized rehabilitation. In contrast, the results show that the positive trend from 2015 to 2019 reported by Tverdal et al ( 14 ) continued in 2020–21. At the start of the pandemic, the discharge may even have been accelerated because of the pressure in the ICU and neurosurgical wards.…”

“…All tests were 2-sided and set 5% significant level. The statistical procedure and selection of variables for the multivariable logistic regression models was built on a previous study from OUH ( 14 ). In brief, univariable and multivariable logistic regressions were performed to examine possible risk factors of differentiating between patients discharged to specialized rehabilitation and patients discharged elsewhere.…”

“…Early initiation of a continuous care and rehabilitation pathway can improve functional outcomes and reduce hospitalization costs for patients with severe TBI ( 12 , 13 ). Hence, a continuous care pathway including specialized rehabilitation has been a goal for the services over the last years ( 14 ). However, during the COVID-19 pandemic, both the non-urgent neurosurgical and the rehabilitation services were downscaled.…”

A retrospective review of patients who sustained traumatic brain injury in Ireland 2014–2019

“…Currently, only 4.6% (47) of severe TBI patients in Ireland are discharged to a rehabilitation unit. This is compared to 64% in Australia and 35-48% in Europe (40, [43][44][45][46]. It is estimated that the implementation of a major trauma system in Ireland will increase survivors requiring rehabilitation further and hence increase pressure on an already limited rehabilitation service (47,48).…”