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J Head Trauma Rehabil. 2015 May-Jun;30(3):E41-51. doi: 10.1097/HTR.0000000000000050.

Associations between care pathways and outcome 1 year after severe traumatic brain injury.

Author information

1
Department of Clinical Sciences, Karolinska Institute, and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, Stockholm, Sweden (Drs Godbolt, Borg, and DeBoussard); Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden (Drs Stenberg and Stålnacke); Department of Clinical Rehabilitation Medicine, County Council, Linköping, Sweden (Dr Lindgren); Department of Rehabilitation Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden (Dr Ulfarsson); and Department of Neuroscience, Uppsala University, Uppsala, and Department of Rehabilitation Medicine, Gävle and Sandviken Hospital, Sandviken, Sweden (Dr Lannsjö). Dr Godbolt was previously with Department of Rehabilitation Medicine, University Hosptial Uppsala and Uppsala University, Uppsala Sweden, during the intial stages of the study.

Abstract

OBJECTIVE:

To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year.

SETTING AND DESIGN:

Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals.

PARTICIPANTS:

Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.

MAIN MEASURES:

Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed.

RESULTS:

A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).

CONCLUSIONS:

Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.

PMID:
24901323
DOI:
10.1097/HTR.0000000000000050
[Indexed for MEDLINE]

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