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Determinants of Admission to Inpatient Rehabilitation Among Acute Care Survivors of Hypoxic-Ischemic Brain Injury: A Prospective Population-Wide Cohort Study

Published:January 29, 2016DOI:https://doi.org/10.1016/j.apmr.2016.01.007

      Abstract

      Objective

      To investigate demographic and acute care clinical determinants of admission to inpatient rehabilitation (IR) among patients with hypoxic-ischemic brain injury (HIBI) who survive the initial acute care episode.

      Design

      Population-wide prospective cohort study using Canadian Institutes for Health Information administrative health data from Ontario, Canada. All patients who survived their HIBI acute care episode during the study period remained eligible for the outcome, admission to IR, for 1 year postacute care discharge.

      Setting

      Inpatient rehabilitation.

      Participants

      We included all patients with HIBI using International Classification of Diseases, Tenth Revision, Canadian Enhancement codes recorded at acute care admission who were ≥20 years old (N=599) and discharged from acute care between the 2002 and 2010 fiscal years, inclusive. Six patients were excluded from analyses because of missing data.

      Interventions

      Not applicable.

      Main Outcome Measure

      Admission to IR.

      Results

      Of HIBI survivors admitted to IR within 1 year of acute care discharge (n=169), most (56.2%) had an IR admitting diagnosis indicating anoxic brain damage. Younger age, being a man, lower comorbidity burden, longer length of stay of preceding acute care episode, and shorter duration in special care were most predictive of admission to IR in multivariable regression models. Women had an almost 2-fold lower incidence of admission to IR (risk ratio, .62; 95% confidence interval, .46–.84).

      Conclusions

      Older age, higher comorbidity burden, and shorter lengths of stay and delayed discharge from acute care are associated with lower incidence of IR admission for patients with HIBI. That women are almost 2-fold less likely to receive rehabilitation requires further investigation.

      Keywords

      List of abbreviations:

      ABI (acquired brain injury), ALC (alternate level of care), HIBI (hypoxic-ischemic brain injury), ICD-10 (International Classification of Diseases, 10th Revision), IR (inpatient rehabilitation), LOS (length of stay), NTBI (nontraumatic brain injury), TBI (traumatic brain injury)
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