Research Reports - Associations between care pathways and outcome after traumatic brain injury

J Head Trauma Rehabil. 2014 Jun 4

Godbolt AK(1), Stenberg M, Lindgren M, Ulfarsson T, Lannsjö M, Stålnacke BM, Borg J, DeBoussard CN

OBJECTIVE:: To assess associations between real-world care pathways for
working-age patients in the first year after severe traumatic brain injury and
outcomes at 1 year.
SETTING AND DESIGN:: Prospective, observational study with recruitment from 6
neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently
of care pathways, by rehabilitation physicians and paramedical professionals.
PARTICIPANTS:: Patients with severe traumatic brain injury, lowest (nonsedated)
Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring
neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.
MAIN MEASURES:: Length of stay in intensive care, time between intensive care
discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale
Extended score), acute markers of injury severity, preexisting medical
conditions, and post-acute complications. Logistic regression analyses were
RESULTS:: A multivariate model found variables significantly associated with
outcome (odds ratio for good outcome [confidence interval], P value) to be as
follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between
intensive care discharge and admission to inpatient rehabilitation (0.97
[0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).
CONCLUSIONS:: Delays in rehabilitation admission were negatively associated with
outcome. Measures to ensure timely rehabilitation admission may improve outcome.
Further research is needed to evaluate possible causation.

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