Representativeness of the Traumatic Brain Injury Model Systems National Database

Abstract

Objective To determine whether the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) is representative of individuals aged 16 years and older admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI). Design Secondary analysis of existing datasets. Setting Acute inpatient rehabilitation facilities. Participants Patients 16 years of age and older with a primary rehabilitation diagnosis of TBI. Interventions None. Main Outcome Measure demographic characteristics, functional status and hospital length of stay. Results From October 2001 through December 2007 patients included in the TBIMS-NDB were largely representative of all individuals 16 years and older admitted for rehabilitation in the U.S. with a primary diagnosis of TBI. The major difference in distribution was age—the TBIMS-NDB cohort did not include as many patients over age 65 as were admitted for rehabilitation with a primary diagnosis of TBI in the United States. Distributional differences for age-related characteristics were observed; however, groups of patients partitioned at age 65 differed minimally, especially the under 65 subset. Regardless of age, the proportion of patients with a rehabilitation stay of 1-9 days was larger nationwide. Nationwide admissions showed an age distribution similar to patients discharged alive from acute care with moderate, severe or penetrating TBI. The proportion of patients age 70 and older admitted for TBI rehabilitation in the United States increased every year, a trend that was not evident in the general population, TBIMS-NDB or among TBI patients in acute care. Conclusions These results provide substantial empirical evidence that the TBIMS-NDB is representative of patients receiving inpatient rehabilitation for TBI in the U.S. Researchers utilizing the TBIMS-NDB may want to adjust statistically for the lower percentage of patients over age 65 or those with stays less than 10 days.

Traumatic brain injury rehabilitation in Riyadh, Saudi Arabia: Time to rehabilitation admission, length of stay and functional outcome

“…The mean 64 days of rehabilitation LOS for all patients in this study is similar to that reported for other European countries [16][17][18], Australia [15], and Saudi Arabia [19]. The USA is an exception, where rehabilitation LOS below 30 days is reported from the model systems national database [38,39]. By itself, LOS is an inadequate way to compare rehabilitation effectiveness, since a longer LOS may reflect inefficiency as much as it indicates increased therapeutic time and a shorter LOS may reflect increased efficiency/intensity or be indicative of cuts in health care provision, as seen in recent decades in the USA [40].…”

“…With an average of four months and a mean of two and a half months for individuals arriving from acute care, and an average of 11 months and mean of seven months for individuals arriving from elsewhere, our findings are notably longer than that reported for the USA and European countries [9][10][11][12]38] and instead are similar to those of lower-income countries [13]. Our values also differ notably from other Saudi Arabian research which has shown mean acute care LOS to be between 50 [14] and 94 days [8].…”

Mortality following Traumatic Brain Injury among Individuals Unable to Follow Commands at the Time of Rehabilitation Admission: A National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems Study

“…However, Corrigan and colleagues found TBIMS NDB to be representative of patients receiving inpatient rehabilitation for TBI in the United States. 30,31 Another consideration is that the findings of the present study represent a select group of individuals who survived injury and acute care hospitalization and received inpatient rehabilitation. This is important as it is currently common for individuals who do not follow commands to either not qualify or not be provided the opportunity to receive any inpatient rehabilitation.…”

Traumatic Brain Injury–Practice Based Evidence Study: Design and Patients, Centers, Treatments, and Outcomes

“…in percentages, which were converted to raw numbers by multiplying each with their respective US TBI population totals. 29,30 The 2001–2007 values were subtracted from the 2001–2010 values to get the 2008–2010 values. These raw numbers were then converted back into percentages using 156,447 − 99,438 = 57,009 as the denominator (our estimate for the US TBI population between 2008 and 2010).…”