Abstract
Objectives
To understand how health status preceding traumatic brain injury (TBI) affects relative
functional gain after inpatient rehabilitation using a data mining approach.
Design
Population-based, sex-stratified, retrospective cohort study using health administrative
data from Ontario, Canada (39% of the Canadian population).
Setting
Inpatient rehabilitation.
Participants
Patients 14 years or older (N=5802; 63.4% male) admitted to inpatient rehabilitation
within 1 year of a TBI-related acute care discharge between April 1, 2008, and March
31, 2015.
Interventions
Not applicable.
Main Outcome Measures
Relative functional gain (RFG) in percentage, calculated as ([discharge FIM−admission
FIM]/[126−admission FIM]×100). Health status prior to TBI was identified and internally
validated using a data mining approach that categorized all International Classification of Diseases, 10th revision, codes for each patient.
Results
The average RFG was 52.8%±27.6% among male patients and 51.6%±27.1% among female patients.
Sex-specific Bonferroni adjusted multivariable linear regressions identified 10 factors
of preinjury health status related to neurology, emergency medicine, cardiology, psychiatry,
geriatrics, and gastroenterology that were significantly associated with reduced RFG
in FIM for male patients. Only 1 preinjury health status category, geriatrics, was
significantly associated with RFG in female patients.
Conclusions
Comorbid health conditions present up to 5 years preceding the TBI event were significantly
associated with RFG. These findings should be considered when planning and executing
interventions to maximize functional gain and to support an interdisciplinary approach.
Best practices guidelines and clinical interventions for older male and female patients
with TBI should be developed given the increasingly aging population with TBI.
Keywords
List of abbreviations:
DAD (Discharge Abstract Database), ICD-10 (International Classification of Diseases, 10th revision), LOS (length of stay), NRS (National Rehabilitation Reporting System), RFG (relative functional gain), TBI (traumatic brain injury)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Position statement: definition of traumatic brain injury.Arch Phys Med Rehabil. 2010; 91: 1637-1640
- Changes in patient demographics and outcomes in the inpatient rehabilitation facility traumatic brain injury population from 2002 to 2016: implications for patient care and clinical trials.J Neurotrauma. 2019; 36: 2513-2520
- Variations in inpatient rehabilitation functional outcomes across centers in the Traumatic Brain Injury Model Systems Study and the influence of demographics and injury severity on patient outcomes.Arch Phys Med Rehabil. 2016; 97: 1821-1831
- Cluster analysis of vulnerable groups in acute traumatic brain injury rehabilitation.Arch Phys Med Rehabil. 2018; 99: 2365-2369
- Longitudinal effects of medical comorbidities on functional outcome and life satisfaction after traumatic brain injury: an individual growth curve analysis of NIDILRR Traumatic Brain Injury Model System data.J Head Trauma Rehabil. 2019; 34: E24-E35
- Sex-specific predictors of inpatient rehabilitation outcomes after traumatic brain injury.Arch Phys Med Rehabil. 2016; 97: 772-780
- Factors associated with rehabilitation outcomes after traumatic brain injury: comparing functional outcomes between TBIMS centers using hierarchical linear modeling.J Head Trauma Rehabil. 2017; 32: E1-E10
- Data mining to understand health status preceding traumatic brain injury.Sci Rep. 2019; 9: 5574
Table 17-10-0005-01 Population estimates on July 1st, by age and sex. Available at: https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000501. Accessed August 26, 2019.
- Discharge abstract database metadata (DAD).(Available at:)https://www.cihi.ca/en/discharge-abstract-database-metadataDate accessed: August 26, 2019
- Rehabilitation minimum data set manual.Canadian Institute for Health Information, Ottawa2018
- National rehabilitation reporting system data quality documentation 2017-2018.Canadian Institute for Health Information, Ottawa2018
- Clinical profile and comorbidity of traumatic brain injury among younger and older men and women: a brief research notes.BMC Res Notes. 2017; 10: 371
- Older adults with acquired brain injury: outcomes after inpatient rehabilitation.Can J Aging. 2013; 32: 278-286
- Direct cost associated with acquired brain injury in Ontario.BMC Neurol. 2012; 12: 1-12
- Defining neurotrauma in administrative data using the International Classification of Diseases Tenth Revision.Emerg Themes Epidemiol. 2011; 8: 4
- Rehospitalization after traumatic brain injury: a population-based study.Arch Phys Med Rehabil. 2016; 97: S19-S25
- Assessment of outcomes following acquired brain injury.in: Teasell R. Cullen N. Marshall S. Janzen S. Bayley M. Evidence-based review of moderate to severe acquired brain injury. Version 11.0. 2017: 1-75
- Rehabilitation impact indices and their independent predictors: a systematic review.BMJ Open. 2013; 3e003483
- Effects of patient preinjury and injury characteristics on acute rehabilitation outcomes for traumatic brain injury.Arch Phys Med Rehabil. 2015; 96: S209-S221
- Influence of sex and age on inpatient rehabilitation outcomes among older adults with traumatic brain injury.Arch Phys Med Rehabil. 2010; 91: 43-50
- Trajectory of functional independent measurements during first five years after moderate and severe traumatic brain injury.J Neurotrauma. 2018; 35: 1596-1603
- Abbreviated Injury Scale.(Available at:)https://www.aaam.org/abbreviated-injury-scale-ais/Date accessed: July 29, 2019
- ICD Injury matrices.(Availble at:)https://www.cdc.gov/nchs/injury/injury_matrices.htmDate accessed: July 29, 2019
- Recommended ICD-10-CA Codes for Injury Core Indicators.(Available at:)http://core.apheo.ca/index.php?pid=306Date accessed: July 29, 2019
- Alternate level of care (ALC) days.(Available at:)http://www.health.gov.on.ca/en/pro/programs/ris/docs/alternate_level_of_care_days_en.pdfDate accessed: July 29, 2019
- Defining pediatric traumatic brain injury using International Classification of Diseases Version 10 Codes: a systematic review.BMC Neurol. 2015; 15: 7
- Brain disorders in Ontario: prevalence, incidence and costs from health administrative data.ICES, Ontario2015
- Ethnic differences in discharge destination among older patients with traumatic brain injury.Arch Phys Med Rehabil. 2008; 89: 231-236
Article info
Publication history
Published online: June 13, 2020
Footnotes
Supported by the Eunice Kennedy Shriver National Institutes of Child Health & Human Development of the National Institutes of Health (award no. R21HD089106). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. T.M. was supported by the postdoctoral research grant from the Alzheimer's Association (no. AARF-16-442937). The funders had no role in the study design, data collection, decision to publish, or preparation of the manuscript.
This study made use of deidentified data from the ICES Data Repository, which is managed by the Institute for Clinical Evaluative Sciences with support from its funders and partners: Canada’s Strategy for Patient-Oriented Research (SPOR), the Ontario SPOR Support Unit, the Canadian Institutes of Health Research, and the Government of Ontario. The opinions, results and conclusions reported are those of the authors. No endorsement by ICES or any of its funders or partners is intended or should be inferred. Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions, and statements expressed herein are those of the authors and not necessarily those of the Canadian Institute for Health Information.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
