Risk factors for acute care transfer among traumatic brain injury patients

Deshpande, Aashish; Millis, Scott R.; Zafonte, Ross; Hammond, Flora M.; Wood, Deborah L.

doi:10.1016/s0003-9993(97)90224-0

Cited by 45 publications

(34 citation statements)

References 18 publications

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“…Low levels of hemoglobin, although not statistically significant, showed a trend toward association in that study. 23 Even though all medical complications may be preventable to some extent, implementation of certain interventions during acute care and rehabilitation may help to reduce the frequencies of certain specific complications. Examples include the early identification of dysphagia to prevent aspiration pneumonia, initiation of anticoagulation therapy to prevent thromboembolism, judicious use of indwelling catheters to prevent urinary tract infections, and frequent body positioning to prevent pressure ulcers.…”

Section: Roth Et Al Medical Complications In Stroke Rehabilitation 527mentioning

confidence: 99%

Incidence of and Risk Factors for Medical Complications During Stroke Rehabilitation

Roth

Lovell

Harvey

et al. 2001

Stroke

241

197

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Background and Purpose-The aims of this study were to examine the frequency, types, and clinical factors associated with medical complications that occur during inpatient rehabilitation and to identify risk factors for complications that require a transfer to an acute care facility. Methods-A cohort of 1029 patients consecutively admitted for inpatient stroke rehabilitation was studied. Demographic and stroke information, impairment, preexisting medical conditions, and admission laboratory abnormalities were recorded. Medical complications, defined as new or exacerbated medical problems, were documented for each patient.Complications that required transfer off rehabilitation were noted. Univariate and multiple logistic regression analyses were used to determine factors that were associated with risk of medical complications and risk of transfer off rehabilitation. Results-Seventy-five percent of patients experienced Ն1 medical complication during rehabilitation.

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Section: Roth Et Al Medical Complications In Stroke Rehabilitation 527mentioning

confidence: 99%

Incidence of and Risk Factors for Medical Complications During Stroke Rehabilitation

Roth

Lovell

Harvey

et al. 2001

Stroke

241

197

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“…An uninterrupted inpatient rehabilitation stay with consistent therapy participation is preferred and the most efficient way to utilize these rehabilitation resources. 6 Because of this, multiple studies have been published that have focused on return to the primary acute care service in a number of patient populations including burn, 7 stroke, 8 traumatic brain injury, 9,10 and cancer patients. Alam et al found a return to primary rate of 21% versus 9.7% of non-cancer controls.…”

Section: Introductionmentioning

confidence: 99%

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Fu¹,

Lee²,

Smith³

et al. 2013

PM&R

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Objective-To assess the frequency and risk factors for return to the primary acute care service among lymphoma patients undergoing inpatient rehabilitation.Design-Retrospective study. Setting-Tertiary referral-based cancer center.Patients-All patients with a history of lymphoma admitted to inpatient rehabilitation between October 1, 2003 and January 30, 2013.Main Outcome Measures-Items analyzed from patient records included return to the primary acute care service with demographic information, lymphoma characteristics, medications, hospital admission characteristics, and laboratory values.Results-143 unique patient admissions were analyzed. 54/143 (38%) of lymphoma inpatient rehabilitation admissions returned to the primary acute care service. However, 16/54 (30%) returned due to needing additional chemotherapy. Excluding patients who returned to the primary acute care service for chemotherapy, statistically significant or approaching statistically significant factors (p<.10) associated with return to the primary acute care service included a creatinine greater than or equal to 1.3 milligrams/deciliter (mg/dL) (p=0.0002), male sex (p=0.001), history Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclosures: NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript of hematopoietic stem cell transplant (p=0.0355), and presence of intravenous antifungal agent (p=0.0717). Of those transferred back to the primary acute care service; 13/38 (34%) discharged directly home, 10/38 (26%) died in the hospital, 7/38 (18%) transferred to a subacute rehabilitation facility, and 4/38 (11%) transferred to inpatient rehabilitation.Conclusions-Chemotherapy was the most common reason for return to the primary acute care service. When excluding patients who returned for chemotherapy, lymphoma patients who are male, who have had a hematopoietic stem cell transplant, and have a creatinine greater than or equal to 1.3 mg/dL demonstrated increased risk for return to the primary acute care service.

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“…It has also been reported in the literature that prolonged LOS negatively affects the FIM scores 14 . Davis reported that basal GCS and duration of hospitalization are related with acute rehabilitation results 12 .…”

Section: Discussionmentioning

confidence: 84%

Rehabilitation outcome after traumatic brain injury

2007

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SummaryRehabilitation goals after traumatic brain injury are improving function, increasing the level of independence as high as possible, preventing complications and providing an acceptable environment to the patient. Several complications can be encountered during the rehabilitation period which lead to physical, cognitive and neurobehavioral impairments that cause major delay in functional improvement. This prospective study was designed in order to investigate the complications and their relations with functional recovery in patients that were included in the acute phase of a rehabilitation program.Thirty traumatic brain injured patients admitted to the Intensive Care Units of Uludag University School of Medicine were included in the study. Rehabilitation program consisted in appropriate positioning, range of motion exercises, postural drainage and respiratory exercises. Complications that were encountered during intensive care rehabilitation program were recorded. All patients were evaluated by Functional Independence Measure, Disability Rating Scale and Ranchos Los Amigos Levels of Cognitive Function Scale at admission and discharge.Improvement was observed in patients in terms of functional outcome and disability levels. Pneumonia, athelectasis, anemia and meningitis were the most frequent complications. Deterioration in functional outcome and disability levels was noted as the number of these complications increased.In conclusion, rehabilitation has an important role in the management of traumatic brain injured patients. Reduction of frequency of complications and improvement in functional outcome and disability levels can be achieved through rehabilitation programs. Long-term controlled studies with large number of patients are needed in order to obtain accurate data on factors associated with rehabilitation outcomes.KEY WORDS: Traumatic brain injury. Rehabilitation. Complication. Resultados de la rehabilitacion despues de sufrir un traumatismo craneoencefálico ResumenEntre los objetivos de la rehabilitación después de un traumatismo craneoencefálico está la mejoría de la función cerebral el aumento del grado de independencia la prevención de complicaciones y la obtención de un ambiente acceptable para el paciente. Durante el período de la rehabilitación pueden producirse varias complicaciones que conducen a discapacidades físicas, cognitivas y otras neurológicas que causan un importante retraso en la mejoría funcional. Este estudio ha sido diseñado para investigar las complicaciones observadas en los pacientes que se incluyeron en un programa de rehabilitación en fase aguda, sus relaciones con el estado funcional y los factores que tienen impacto en los resultados de la rehabilitación.Se incluyen en el estudio treinta pacientes con traumatismo craneoencefálico admitidos en la Unidad de Cuidados Intensivos de la Escuela de Medicina de la Universidad de Uludag. El programa de rehabilitación consistió en rehabilitación postural, una serie de ejercicios de movimiento, y ejercicios respiratorios. Se regist...

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Risk factors for acute care transfer among traumatic brain injury patients

Cited by 45 publications

References 18 publications

Incidence of and Risk Factors for Medical Complications During Stroke Rehabilitation

Incidence of and Risk Factors for Medical Complications During Stroke Rehabilitation

Frequency and Reasons for Return to the Primary Acute Care Service among Lymphoma Patients Undergoing Inpatient Rehabilitation

Rehabilitation outcome after traumatic brain injury

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