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

Abstract

Objective: To quantify potential changes in direct referral to early specialized rehabilitation during the COVID-19 pandemic and the injury pattern of patients hospitalized with traumatic brain injury (TBI) at a level 1 trauma centre.Methods: In this registry-based study, data were retrieved from the Oslo TBI Registry-Neurosurgery and included adult patients with injury-related intracranial findings admitted to Oslo University Hospital (OUH). The study focused on a period of time when OUH was in any level of preparedness because of the COVID-19 pandemic; March 2020 to August 2021. For comparison, the study used patients hospitalized for TBI in 2018 and 2019.Results: A total of 1,310 hospitalized patients with TBI were divided into 2 groups; pre-pandemic and pandemic. Direct referral to early rehabilitation was maintained. Patient volume remained stable, and there were no differences between the groups regarding patient characteristics and acute management, although there was a significantly higher proportion of TBIs secondary to electric scooter accidents in the pandemic group. Results from univariable and multivariable logistic regression showed a multifaceted reality, but younger age, none or mild preinjury comorbidity and severe disability due to TBI at discharge from acute care remained stable strong predictors of direct referral to rehabilitation.Conclusion: For patients with moderate-severe TBI, the direct pathway to early specialized rehabilitation was maintained during 2020–21. However, the pandemic continued and the long-term impact for rehabilitation services is not yet known.

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

“…We assume that this effect was most pronounced for specialized rehabilitation, with the possibility of underestimating the proportion of patients discharged under non-pandemic circumstances. However, a study performed at OUH that looked at the period from March 2020 to August 2021 found that for patients with moderate-to-severe TBI, the direct pathway to early specialized rehabilitation was maintained (Tverdal et al 2022 ). Dropout analysis (non-responders or declined participation) revealed no significant differences in sex or mean age between the dropouts and the included patients.…”

Evolution of rehabilitation services in response to a global pandemic: reflection on opportunities and challenges ahead

“…This was not a global response; in other parts of the world rehabilitation services were deemed more of a priority. A registry-based study from Norway, including 1310 hospitalized patients with traumatic brain injury (TBI), demonstrated that the direct pathway to early specialized rehabilitation was maintained during 2020–2021 ( 38 ). Similarly, while Japan commonly follows the recommendations of the CDC and WHO, the Japanese government and the leading Medical Rehabilitation Organization did not recommend early discharge from the hospital ( 39 , 40 ).…”

Changing Epidemiology and Functional Outcomes of Inpatient Rehabilitation in Asian Traumatic Brain Injury Cases before and during the COVID-19 Pandemic: A Retrospective Cohort Study

“…Literature pertaining to the impact of the COVID-19 pandemic on TBI rehabilitation profiles and outcomes are unknown, in particular in regards Asian TBI [17]. We aimed to study the effects of the COVID-19 pandemic on inpatient TBI case-mix and rehabilitation outcomes by comparing two unique cohorts from similar duration pre and post pandemic periods.…”