Predictors of Access to Rehabilitation in the Year Following Traumatic Brain Injury: A European Prospective and Multicenter Study

Abstract

Background Although rehabilitation is beneficial for individuals with traumatic brain injury (TBI), a significant proportion of them do not receive adequate rehabilitation after acute care. Objective Therefore, the goal of this prospective and multicenter study was to investigate predictors of access to rehabilitation in the year following injury in patients with TBI. Methods Data from a large European study (CENTER-TBI), including TBIs of all severities between December 2014 and December 2017 were used (N = 4498 patients). Participants were dichotomized into those who had and those who did not have access to rehabilitation in the year following TBI. Potential predictors included sociodemographic factors, psychoactive substance use, preinjury medical history, injury-related factors, and factors related to medical care, complications, and discharge. Results In the year following traumatic injury, 31.4% of patients received rehabilitation services. Access to rehabilitation was positively and significantly predicted by female sex (odds ratio [OR] = 1.50), increased number of years of education completed (OR = 1.05), living in Northern (OR = 1.62; reference: Western Europe) or Southern Europe (OR = 1.74), lower prehospital Glasgow Coma Scale score (OR = 1.03), higher Injury Severity Score (OR = 1.01), intracranial (OR = 1.33) and extracranial (OR = 1.99) surgery, and extracranial complication (OR = 1.75). On contrast, significant negative predictors were lack of preinjury employment (OR = 0.80), living in Central and Eastern Europe (OR = 0.42), and admission to hospital ward (OR = 0.47; reference: admission to intensive care unit) or direct discharge from emergency room (OR = 0.24). Conclusions Based on these findings, there is an urgent need to implement national and international guidelines and strategies for access to rehabilitation after TBI.

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

“…The statistical models demonstrated the striking impact of age, which is discussed in a separate paragraph. Neurosurgical procedures were significant predictors in univariate regression but not in multivariate models, which is inconsistent with the study by Jacob et al [11]. In fact, 42% of patients following the direct pathway were treated without surgical procedures.…”

“…Half of the patient population was admitted with complicated mild TBI, and one-third was discharged to home. In line with previous research, patients with moderate-severe TBI dominated in the direct pathway group [11,12]. For patients with severe TBI, 39% followed the direct pathway, which was slightly lower than that in previous European studies (40-48%) [8,12,14,30].…”

“…We found no support for the notion that patients with preinjury substance dependence are downgraded for the direct pathway, which was in contrast to findings by Jourdan et al [12] but in line with other studies [11,13,14]. In our study, access to sociodemographic variables was limited.…”

“…Clinical factors positively associated with access to TBI rehabilitation include more severe injury (moderate to severe TBI), intracranial and extracranial surgery, length of stay and impaired function [11,12]. Studies determining the predictive value of demographics demonstrate that younger age is associated with discharge to rehabilitation and that the association of sex is uncertain [13].…”

“…Studies determining the predictive value of demographics demonstrate that younger age is associated with discharge to rehabilitation and that the association of sex is uncertain [13]. Social factors negatively associated with access to rehabilitation are low level of education, unemployment, and substance abuse [8,11,12,14]. In stroke patients, studies suggest that reduced preinjury functional levels negatively influence the decision to refer to rehabilitation [15,16].…”