Rehabilitation pathways and functional independence one year after severe traumatic brain injury

Abstract

BACKGROUND: After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI. AIM: To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury. DESIGN: Observational prospective multicenter study. SETTING: Regional trauma centers. POPULATION: A total of 163 adults, age 16-85 years, with severe TBI. METHODS: The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence. Results: 75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were trans- ferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01). CONCLUSIONS: A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence. CLINICAL REHABILITATION IMPACT: Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.