Do rehospitalization rates differ among injury severity levels in the NIDRR Traumatic Brain Injury Model Systems program?

Abstract

Objective: To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.

Design: Prospective observational study.

Setting: Inpatient rehabilitation within TBIMS with annual follow-up.

Participants: Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).

Interventions: Not applicable.

Main outcome measures: Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.

Results: The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.

Conclusions: Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.

Keywords: CI; Consciousness disorders; DOC; DRS; Disability Rating Scale; ED; GCS; Glasgow Coma Scale; IRR; LSM; MCS; NIDRR; National Institute on Disability and Rehabilitation Research; Rehabilitation; TBI; TBI Model Systems; TBIMS; TFC; Traumatic brain injuries; VS; confidence interval; disorders of consciousness; emergency department; incidence rate ratio; least squares mean; minimally conscious state; time to follow commands; traumatic brain injury; vegetative state.