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Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)

Factors associated with receiving inpatient rehabilitation after traumatic brain injury in a county hospital system

Thursday, November 10, 2022

4:12 PM – 4:17 PM

Location: Station 2

Non-presenting Author(s)

AM

Amy Mathews

Assistant Professor
UT Southwestern Medical Center, United States
SB

Surbhi Banubakode, n/a

Medical Student
McGovern Medical School, Texas, United States
Julia Hughes, M.S. CCC-SLP, CBIS

speech language pathologist
Parkland
Dallas, Texas, United States

Presenting Author(s)

Brittany Wright, PhD

Postdoctoral fellow
UT Southwestern
Carrollton, Texas, United States

Non-presenting Author(s)

MN

Marielle Nagele, MS

Clinical Research Manager
UT Southwestern Medical Center
Richardson, Texas, United States
YW

Yusra Waris, n/a

Student
University of Texas at Dallas, Texas, United States
Shannon B. Juengst, PhD, CRC

Clinical Investigator and Adjunct Associate Professor
TIRR Memorial Hermann
Houston, Texas, United States

Research Objectives: To characterize factors associated with inpatient rehabilitation for individuals with Traumatic Brain Injury (TBI) presenting to an Emergency Department (ED) at a local county hospital.

Design: Retrospective Chart Review

Setting: Emergency Department

Participants: Patients (n=904) with International Classification of Diseases (ICD) codes consistent with possible TBI (i.e., motor vehicle collisions, motor vehicle accidents, falls, polytrauma, traumatic brain injury, and concussion).

Interventions: Not Applicable

Main Outcome Measures: Inpatient rehabilitation (Yes/No) after moderate-severe TBI as defined by the TBI Model Systems criteria (trauma-related imaging abnormalities, loss of consciousness >30 minutes, post-traumatic amnesia >24 hours, and/or Glasgow Coma Scale score < 13).1,2

Results: Of the 904 patients, 152 met criteria for a moderate-severe TBI based on the TBI Model Systems criteria. Most of the patients with TBI (67.1%) went home after their time in the ED and did not go directly to inpatient rehabilitation. Compared to the patients that did receive inpatient rehabilitation (n=31), those that did not (n=121) were more likely to be uninsured (21.5% vs. 6.5%), Spanish speakers (20.7% vs. 9.7%), and ethno-racial minorities (57.9% vs. 35.5%). Additionally, patients that received inpatient rehabilitation sustained more severe injuries as noted by lower GCS scores, intubation/sedation at time of admission, or not being able to walk or swallow at discharge from the ED.

Conclusions: In our study, similar to prior research, factors like insurance status,3 race,4,5,6 primary language spoken, and injury severity differed between patients that did versus those that did not receive inpatient rehabilitation. Future research should assess potential reasons for these differences and work to improve access to rehabilitation after TBI.

Author(s) Disclosures: The authors report no conflicts of interest.

Learning Objectives:

Describe differences between patients who received inpatient rehabilitation versus those that did not in this large, urban county hospital system.
List relevant International Classification of Diseases (ICD) codes associated with sustaining a traumatic brain injury (TBI) and criteria for moderate-severe TBI according to the TBI Model Systems.
List potential reasons for lack of access to rehabilitation after TBI and discuss the clinical implications of our findings.