Etiology and incidence of rehospitalization after traumatic brain injury: A multicenter analysis

doi:10.1016/S0003-9993(99)90312-X

Archives of Physical Medicine and Rehabilitation

Volume 80, Issue 1, January 1999, Pages 85-90

https://doi.org/10.1016/S0003-9993(99)90312-X Get rights and content

Abstract

Objective: To investigate incidence and etiology of rehospitalizations at 1, 2, and 3 years after traumatic brain injury.

Design: Descriptive statistics were computed in a prospective study of etiology and incidence of rehospitalization at years 1, 2, and 3 postinjury. Analysis of variance (ANOVA) and χ² were used to identify factors relating to rehospitalization; factors included length of stay, admission and discharge functional status, payer source, medical complications, injury severity, and demographics.

Setting: Four medical centers in the federally sponsored Traumatic Brain Injury Model Systems. In each setting, the continuum of care includes emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services.

Participants: Six hundred sixty-five rehabilitation patients admitted to acute care within 24 hours of traumatic brain injury between 1989 and 1996.

Main Outcome Measures: Annual incidence and etiology of rehospitalization.

Results: The annual incidence of rehospitalization ranged from 20% to 22.5%. Approximately half the rehospitalizations were for elective reasons. The most common reason for rehospitalization was for orthopedic or reconstructive surgery, followed by infectious disorders and general health maintenance. After the first year, the incidence of readmissions for seizures and psychiatric difficulties increased substantially. ANOVA and χ² analyses were performed on data from the first year postinjury. No statistically significant associations were noted between incidence and etiology of rehospitalization and: demographics; injury severity; payer source for rehabilitation; concurrent injuries; acute care and rehabilitation length of stays; discharge Functional Assessment Measure; and discharge residence (p > .05).

Conclusions: There is a relatively stable but high rate of rehospitalization for at least 3 years after injury. The costs of rehospitalization should be considered when evaluating the long-term consequences of injury.

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Readmissions After Acute Hospitalization for Traumatic Brain Injury
2019, Journal of Surgical Research
Citation Excerpt :
Readmission for infectious issues was also common with septicemia, urinary tract infections, and respiratory infections among the most common diagnoses for readmissions within 30 d. Infectious complications became even more prevalent with septicemia, the most common APR-DRG grouping when characterizing any readmission during the study period. Hospital readmission is common for patients after suffering TBI.5,6 In this study characterizing readmission rates using a national database, we identified a readmission rate of 13.9% at 30 d and 34.7% at up to 1 y after the index admission.
Traumatic brain injury (TBI) is associated with functional deficits, impaired cognition, and medical complications that continue well after the initial injury. Many patients seek medical care at other health care facilities after discharge, rather than returning to the admitting trauma center, making assessment of readmission rates and readmission diagnoses difficult to determine. The objective of this study was to determine the incidence and factors associated with readmission to any acute care hospital after an index admission for TBI.
The Nationwide Readmission Database was queried for all patients admitted with a TBI during the first 3 mo of 2015. Nonelective readmissions for this population were then collected for the remainder of 2015. Patients who died during the index admission were excluded. Demographic data, injury mechanism, type of TBI, the number of readmissions, days from discharge to readmission, readmission diagnosis, and mortality were studied.
Of the 15,277 patients with an index admission for TBI, 5296 patients (35%) required at least 1 readmission. Forty percent of readmissions occurred within the first 30 d after discharge from the index trauma admission. The most common primary diagnosis on readmission was SDH, followed by septicemia, urinary tract infection, and aspiration. Readmission rates increased with age, with 75% of readmissions occurring in patients aged >65 y. Initial discharge to a skilled nursing facility (Relative Risk [RR], 1.60) or leaving the hospital against medical advice (RR, 1.59) increased the risk of readmission. Patients with fall as their mechanism of injury and a subdural hematoma were more likely to require readmission compared with other types of mechanisms with TBI (RR, 1.59 and RR, 1.21, respectively; P < 0.001). Notably, the first readmission was to a different hospital for 39.5% of patients and 46.9% of patients had admissions to at least one facility outside that of their original presentation.
Hospital readmission is common for patients discharged after TBI. Elderly patients who fall with resultant subdural hematoma are at especially high risk for complications and readmission. Understanding potentially preventable causes for readmission can be used to guide discharge planning pathways to decrease morbidity in this patient population.
Hospital-Based Health Care After Traumatic Brain Injury
2017, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Findings from this regional database represent a platform to better understand care utilization after TBI. The preponderance of medical care used within the first year after injury has been detailed in prior samples, but the surprisingly low rate of care utilization after the first year is well below that of prior studies.23,28,29 Most likely, the inclusion of all TBI severity levels resulted in a larger portion of milder injuries.
To investigate trends of hospital-based health care utilization after admission to a level I trauma center after acute traumatic brain injury (TBI).
Retrospective review.
Large urban trauma hospital and a hospital council data registry consisting of 88 member institutions (>150 hospitals) covering 15,000 square miles.
All patients (N=5291) admitted to a level I trauma center between January 1, 2006, and June 30, 2014, who experienced an acute TBI based on International Classification of Diseases, Ninth Revision coding.
Not applicable.
Included the incidence and type of select hospital-based services received. Analyses were also categorized based on demographic and injury-related information.
Of the 5291 patients with newly acquired TBI who were admitted, 512 died, leaving 4779 patients for inclusion in the final analysis. Additional health care utilization from January 1, 2006, and June 30, 2014, was recorded for 3158 patients (66%), totaling 12,307 encounters, with a median of 3 encounters (interquartile range, 1–5) and a maximum of 102 encounters. Most nonadmission urgent or procedural visits (96%) and inpatient encounters (93%) occurred in the first year. Of all the additional encounters, 9769 visits were nonadmission urgent or procedural visits (79%) with a median charge of $1955. The most common type of encounter was elective (46%), followed by medical emergency (29%). Of the remaining 2538 inpatient encounters (21%), the mean length of stay was 6 days with a median charge of $28,450. Medical emergency (39%) and elective admissions (33%) again were the most common encounter type.
This analysis encompasses health care utilization across the range of TBI severity and numerous hospital systems, allowing for a more comprehensive and objective identification of reasons for readmission. This represents an initial step to developing a preventive intervention to manage secondary complications postinjury.
Rehospitalization after traumatic brain injury: A population-based study
2016, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
These findings provide a valuable framework for the development of targeted intervention programs for those at greatest risk for recurrent hospitalization after TBI. The rate of rehospitalization for patients with TBI in the present study was higher than previously reported rates of 16% to 23%.12-16 This might be because all hospitalizations could be effectively tracked within a publicly insured population.
To examine, from a Canadian population-based perspective, the incidence and etiology of long-term hospital utilization among persons living with traumatic brain injury (TBI) by age and sex.
Retrospective cohort study.
Acute care hospitals.
Index cases of TBI (N=29,269) were identified from the Discharge Abstract Database for fiscal years 2002/2003 through 2009/2010 and were followed-up until 36 months after injury.
Not applicable.
Rehospitalization was defined as admission to an acute care facility that occurred up to 36 months after index injury. Diagnoses associated with subsequent rehospitalization were examined by age and sex.
Of the patients with TBI, 35.5% (n=10,390) were subsequently hospitalized during the 3-year follow-up period. Multivariable logistic regression (controlling for index admission hospital) identified men, older age, mechanism of injury being a fall, greater injury severity, rural residence, greater comorbidity, and psychiatric comorbidity to be significant predictors of rehospitalization in a 3-year period postinjury. The most common causes for rehospitalization differed by age and sex.
Rehospitalization after TBI is common. Factors associated with rehospitalization can inform long-term postdischarge planning. Findings also support examining causes for rehospitalization by age and sex.
Rehospitalization During 9 Months After Inpatient Rehabilitation for Traumatic Brain Injury
2015, Archives of Physical Medicine and Rehabilitation
Citation Excerpt :
Causes of rehospitalizations during the first month after discharge were generally similar to those that occurred across the full 9-month surveillance time frame. The rates of rehospitalization after inpatient rehabilitation discharge in the first 9 months post-TBI were slightly higher (28%) than the 21% to 23% reported in the 3 TBIMS registry cohorts.16-18 More frequent surveying of participants in the follow-up window and recording of rehospitalizations for new injury may at least partially account for the higher reported rates in this study.
To assess the frequency of, causes for, and factors associated with acute rehospitalization during 9 months after discharge from inpatient rehabilitation for traumatic brain injury (TBI).
Multicenter observational cohort.
Community.
Individuals with TBI (N=1850) admitted for inpatient rehabilitation.
Not applicable.
Occurrences of proxy or self-report of postrehabilitation acute care rehospitalization, as well as length of and causes for rehospitalizations.
A total of 510 participants (28%) had experienced 775 acute rehospitalizations. All experienced 1 admission (510 participants [66%]), whereas 154 (20%) had 2 admissions, 60 (8%) had 3, 23 (3%) had 4, 27 had between 5 and 11, and 1 had 12. The most common rehospitalization causes were infection (15%), neurological (13%), neurosurgical (11%), injury (7%), psychiatric (7%), and orthopedic (7%). The mean time from rehabilitation discharge to first rehospitalization was 113 days. The mean rehospitalization duration was 6.5 days. Logistic regression analyses revealed that older age, history of seizures before injury or during acute care or rehabilitation, history of brain injuries, and non–brain injury medical severity increased the risk of rehospitalization. Injury etiology of motor vehicle collision and high motor functioning at discharge decreased rehospitalization risk.
Approximately 28% of patients with TBI were rehospitalized within 9 months of TBI rehabilitation discharge owing to various medical and surgical reasons. Future research should evaluate whether some of these occurrences may be preventable (such as infections, injuries, and psychiatric disorders) and should evaluate the extent to which persons at risk may benefit from additional screening, surveillance, and treatment protocols.
Do rehospitalization rates differ among injury severity levels in the NIDRR traumatic brain injury model systems program?
2013, Archives of Physical Medicine and Rehabilitation
To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.
Prospective observational study.
Inpatient rehabilitation within TBIMS with annual follow-up.
Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).
Not applicable.
Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.
The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.
Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.
Characteristics of Individuals with Moderate-to-Severe Traumatic Brain Injury and Predictors of Specialized Rehabilitation: A Retrospective Cohort Study
2023, Research Square

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^☆: Supported in part by grant H133B80029 from the National Institute on Disability and Rehabilitation Research, United States Department of Education. Data were contributed by Santa Clara Valley Medical Center, Rehabilitation Institute of Michigan, The Institute of Rehabilitation and Research, and the Medical College of Virginia, Virginia Commonwealth University, Richmond, VA.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

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ArticleEtiology and incidence of rehospitalization after traumatic brain injury: A multicenter analysis☆,☆☆

Abstract

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Arch Phys Med Rehabil

Head injury-associated deaths in the United States from 1979 to 1986

JAMA

Trends in death associated with traumatic brain injury, 1979–1992: success and failure

JAMA

The incidence of acute brain injury and serious impairment in a defined population

Am J Epidemiol

The impact of acute complications, fractures, and motor deficits on functional outcome and length of stay after traumatic brain injury: a multicenter analysis

J Head Trauma Rehabil

Primary health care needs of persons with physical disabilities: what are the research and service priorities

Arch Phys Med Rehabil

Rehospitalization after initial rehabilitation for acute spinal cord injury: incidence and risk factors

Arch Phys Med Rehabil

The economic impact of spinal cord injury

Outcome after stroke in patients discharged to independent living

Stroke

Functional improvement in severe head injury after readmission for rehabilitation

Brain Inj

Article
Etiology and incidence of rehospitalization after traumatic brain injury: A multicenter analysis☆,☆☆