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Predictors of Extended Rehabilitation Length of Stay After Traumatic Brain Injury

  • Juan Carlos Arango-Lasprilla
    Correspondence
    Reprint requests to Juan Carlos Arango-Lasprilla, PhD, Dept of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Rehabilitation Psychology and Neuropsychology, VCU West Hospital, 3rd Fl, Rm 3-102, 1200 E Broad St, Richmond, VA 23298
    Affiliations
    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA
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  • Jessica M. Ketchum
    Affiliations
    Department of Biostatistics, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA
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  • David Cifu
    Affiliations
    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA

    Physical Medicine and Rehabilitation Service, Richmond Veterans Administration Medical Center, Richmond, VA
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  • Flora Hammond
    Affiliations
    Indiana University School of Medicine, Indianapolis, IN

    Carolinas Rehabilitation, Charlotte, NC
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  • Camilo Castillo
    Affiliations
    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA
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  • Elizabeth Nicholls
    Affiliations
    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA
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  • Thomas Watanabe
    Affiliations
    Moss Rehab/Albert Einstein Medical Center, Philadelphia, PA
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  • Anthony Lequerica
    Affiliations
    Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark

    Kessler Foundation, West Orange, NJ
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  • Xiaoyan Deng
    Affiliations
    Department of Biostatistics, Virginia Commonwealth University, Richmond, VA

    Center for Rehabilitation Sciences and Engineering, Virginia Commonwealth University, Richmond, VA
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      Abstract

      Arango-Lasprilla JC, Ketchum JM, Cifu D, Hammond F, Castillo C, Nicholls E, Watanabe T, Lequerica A, Deng X. Predictors of extended rehabilitation length of stay after traumatic brain injury.

      Objective

      To develop a prediction rule for acutely identifying patients at risk for extended rehabilitation length of stay (LOS) after traumatic brain injury (TBI) by using demographic and injury characteristics.

      Design

      Retrospective cohort study.

      Setting

      Traumatic Brain Injury Model Systems.

      Participants

      Sample of TBI survivors (N=7284) with injuries occurring between 1999 and 2009.

      Interventions

      Not applicable.

      Main Outcome Measures

      Extended rehabilitation LOS defined as 67 days or longer.

      Results

      A multivariable model was built containing FIM motor and cognitive scores at admission, preinjury level of education, cause of injury, punctate/petechial hemorrhage, acute-care LOS, and primary payor source. The model had good calibration, excellent discrimination (area under the receiver operating characteristic curve = .875), and validated well. Based on this model, a formula for determining the probability of extended rehabilitation LOS and a prediction rule that classifies patients with predicted probabilities greater than 4.9% as at risk for extended rehabilitation LOS were developed.

      Conclusions

      The current predictor model for TBI survivors who require extended inpatient rehabilitation may allow for enhanced rehabilitation team planning, improved patient and family education, and better use of health care resources. Cross-validation of this model with other TBI populations is recommended.

      Key Words

      List of Abbreviations:

      AUC (area under the curve), DAI (diffuse axonal injury), GCS (Glasgow Coma Scale), GED (general equivalency diploma), LOS (length of stay), MVC (motor vehicle collision), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model System)
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