Research Reports - Predicting institutionalization after traumatic brain injury inpatient rehabilitation

J Neurotrauma. 2015 Feb 15;32(4):280-6

Eum RS(1), Seel RT, Goldstein R, Brown AW, Watanabe TK, Zasler ND, Roth EJ,
Zafonte RD, Glenn MB

Risk factors contributing to institutionalization after inpatient rehabilitation
for people with traumatic brain injury (TBI) have not been well studied and need
to be better understood to guide clinicians during rehabilitation. We aimed to
develop a prognostic model that could be used at admission to inpatient
rehabilitation facilities to predict discharge disposition. The model could be
used to provide the interdisciplinary team with information regarding aspects of
patients' functioning and/or their living situation that need particular
attention during inpatient rehabilitation if institutionalization is to be
avoided. The study population included 7219 patients with moderate-severe TBI in
the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from
2002-2012 who had not been institutionalized prior to injury. Based on
institutionalization predictors in other populations, we hypothesized that among
people who had lived at a private residence prior to injury, greater dependence
in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence,
feeding, and comprehension at admission to inpatient rehabilitation programs
would predict institutionalization at discharge. Logistic regression was used,
with adjustment for demographic factors, proxy measures for TBI severity, and
acute-care length-of-stay. C-statistic and predictiveness curves validated a
five-variable model. Higher levels of independence in bladder management
(adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair
transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI,
0.68, 0.89]) at admission were associated with lower risks of
institutionalization on discharge. For every 10-year increment in age was
associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29,
1.48) and living alone was associated with a 2.34 times higher risk (95% CI,
1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model can
predict risk of institutionalization after inpatient rehabilitation for patients
with TBI.

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