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Rates and Reasons for Rehospitalization up to 10 Years post-TBI: A TBI Model Systems Study
Oral Presentations Participants: 4,778 individuals treated in the TBI Model System facilities from 10/01/2009 through 12/31/2012, weighted to represent the 99,339 adults receiving inpatient rehabilitation across the United States during the same time period with a primary diagnosis of TBI. Interventions: N/A. Main Outcome Measure(s): Global Outcome MeasuredExtended (GOSE), Supervision Rating Scale (SRS), FIMä, Participation Assessed with Recombined ToolsdObjective (PART-O), and Satisfaction with Life Scale (SWLS). Results: An estimated 19,781 (19.9%) died within 5 years of injury, with the highest rate among the elderly. Among the survivors, 31.7% improved on the GOS-E between 1 and 5 years post injury, while 28.3% declined. Improvement was most common among younger women and decline was most common among older men. Differences in patterns of change among demographic subgroups were also found in the SRS, FIM, and PART-O. Conclusions: These population-based trends in outcomes, analyzed by demographic subgroups, may help healthcare providers and policy-makers better plan for the needs of people who receive inpatient rehabilitation for TBI. Key Words: Brain Injury, Outcome assessment, Rehabilitation, Epidemiologic methods Disclosure(s): None Disclosed. Oral Presentation 3916 Intraventricular Hemorrhage on Early CT Predicts Poorer Short- and Long-term Outcome in Moderate to Severe Traumatic Brain Injury Robert G. Kowalski (Craig Hospital), Alan Weintraub, Dave Mellick, Tammie Nakamura, Don Gerber, Cynthia Harrison-Felix Objective(s): To evaluate whether intraventricular hemorrhage (IVH) on early CT independently predicts outcome in TBI. Design: Retrospective analysis of prospectively gathered data. Setting: Rocky Mountain Regional Brain Injury System. Participants: Patients enrolled in the Traumatic Brain Injury Model Systems (TBIMS) National Database at a single center. Interventions: No study specific interventions. Main Outcome Measure(s): Duration of post-traumatic amnesia (PTA); Glasgow Coma Scale (GCS), Glasgow Outcome Scale - Extended (GOSE), FIMTM, Supervision Rating Scale (SRS) at acute rehabilitation admission and discharge or at follow up 1, 2 and 5 years after injury. Results: Between 1998 and 2014, 707 adult TBI patients with computed tomography (CT) were enrolled in the TBIMS database. Mean age was 36 14 years, and 77% were male. IVH was observed in 170 (24%) patients. In univariate analyses, patients with IVH were less likely to follow commands at injury onset, and had longer PTA, and lower FIM total scores at rehabilitation admission and discharge. IVH patients were more likely to have concurrent subarachnoid hemorrhage, frontal cortical contusion, and white matter contusion. Independent predictors of poorer outcome (GOS-E scores 1-4) at one-year follow up were higher frequency of Charlson Index comorbidities (AOR, 1.443; 95% CI, 1.0991.894; pZ0.008), IVH (AOR, 2.049; 95% CI, 1.312-3.205; pZ0.002), subcortical contusion (AOR, 2.433; 95% CI, 1.447-4.098, pZ0.001) and midline shift or cistern compression (AOR, 2.096; 95% CI, 1.389-3.175; p<0.001). IVH also independently predicted longer PTA duration, longer time to resume following commands, and continuing dependence (SRS>1) one year after injury. IVH did not predict outcome at 2- and 5year follow up. Conclusions: Intraventricular hemorrhage on early CT independently predicts poorer short- and long-term outcome in TBI. These findings may help guide intervention, and prognosis when IVH is present on acute CT imaging. Evidence suggesting that IVH observed on CT may be a surrogate marker for white matter injury warrants further study with MRI imaging. Key Words: Intraventricular hemorrhage, Traumatic brain injury, Outcome, Neuroanatomic Disclosure(s): None.
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e7 Oral Presentation 3960 Rates and Reasons for Rehospitalization up to 10 Years post-TBI: A TBI Model Systems Study Alexandra T. Landau (Icahn School of Medicine at Mount Sinai), Kristen Dams-O’Connor Objective(s): To investigate the rates and causes of rehospitalization at 1, 2, 5, and 10 years post-traumatic brain injury (TBI). Design: Cross sectional descriptive analyses at 1, 2, 5, and 10 years post-injury. Setting: Traumatic Brain Injury Model Systems (TBIMS) research centers. Participants: 7,503 individuals with moderate-severe TBI who received inpatient rehabilitation and enrolled in the TBIMS National Database between 2004 and 2014. Mean (SD) age of the sample was 42(19) years, 73% were male, and racial group membership was primarily white (70%) followed by Black (17%), Hispanic (10%), and Other (4%). Interventions: N/A. Main Outcome Measure(s): Self- or proxy-reported rehospitalization in past year. Results: The overall rates of rehospitalization declined over the 1-, 2-, and 5-year follow-up periods (28%, 23%, 22% respectively), and slightly increased at the 10-year follow-up period (23%). Primary reasons for rehospitalization fluctuated over time; Orthopedic conditions was the primary reason for rehospitalization at 1-year follow-up (29%) and General Health Maintenance was the primary reason at 2-, 5-, and 10-year followups (29%, 33%, and 34% respectively). Rehospitalization due to psychiatric disorders was the only admission reason that showed a slight increase in proportion of readmissions across follow-up periods (31% to 35% between the 1- and 2-year follow-up periods). Conclusions: The findings suggest that rates of rehospitalization remain unacceptably high even 10 years post-injury. The fluctuations in reasons for rehospitalization over this time period may inform intervention and prevention efforts for TBI survivors. The frequency of rehospitalization for general health reasons suggests that long-term health management interventions may be particularly important for this population. Key Words: Brain Injuries, Outcome Assessment (Health Care), Delivery of Health Care, Patient Readmission Disclosure(s): None. Oral Presentation 3967 Biopsychosocial Outcomes in the First Year after Traumatic Brain Injury: Behavior, Depressive Symptoms, and Self-Perception Shannon B. Juengst (University of Pittsburgh), Patricia M. Arenth, Amy Wagner Objective(s): To investigate relationships among behavior, depressive symptoms, self-perception, cognition, and Activity Limitations after traumatic brain injury (TBI). Design: An inception cohort of adults with moderate to severe TBI. Setting: Participants were recruited from an acute medical facility and followed as they returned to the community. Participants: 63 participants with moderate to severe TBI recruited through multiple studies (nZ47 at 6 months, nZ46 at 12 months). Inclusion: Documented TBI; Complete data for all measures. Interventions: N/A. Main Outcome Measure(s): The outcome measures are: Behavior (Frontal Systems Behavior Scale), Depressive Symptoms (Patient Health Questionnaire-9), Self-Perception (Percent Back to Normal, a measure of the self-perceived return to pre-injury functioning), Cognition (Neuropsychological Test Battery), and activity limitations (Functional Independence Measure). Results: Behavior, Depressive Symptoms, Self-Perception, and Activity Limitations were all highly correlated with each other (r>.30, p<.05) at 6 and 12 months, while Cognition was only significantly associated with Activity Limitations at 6 and 12 months and Self-Perception at 6 months.
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e7 Oral Presentation 3960 Rates and Reasons for Rehospitalization up to 10 Years post-TBI: A TBI Model Systems Study Alexandra T. Landau (Icahn School of Medicine at Mount Sinai), Kristen Dams-O’Connor Objective(s): To investigate the rates and causes of rehospitalization at 1, 2, 5, and 10 years post-traumatic brain injury (TBI). Design: Cross sectional descriptive analyses at 1, 2, 5, and 10 years post-injury. Setting: Traumatic Brain Injury Model Systems (TBIMS) research centers. Participants: 7,503 individuals with moderate-severe TBI who received inpatient rehabilitation and enrolled in the TBIMS National Database between 2004 and 2014. Mean (SD) age of the sample was 42(19) years, 73% were male, and racial group membership was primarily white (70%) followed by Black (17%), Hispanic (10%), and Other (4%). Interventions: N/A. Main Outcome Measure(s): Self- or proxy-reported rehospitalization in past year. Results: The overall rates of rehospitalization declined over the 1-, 2-, and 5-year follow-up periods (28%, 23%, 22% respectively), and slightly increased at the 10-year follow-up period (23%). Primary reasons for rehospitalization fluctuated over time; Orthopedic conditions was the primary reason for rehospitalization at 1-year follow-up (29%) and General Health Maintenance was the primary reason at 2-, 5-, and 10-year followups (29%, 33%, and 34% respectively). Rehospitalization due to psychiatric disorders was the only admission reason that showed a slight increase in proportion of readmissions across follow-up periods (31% to 35% between the 1- and 2-year follow-up periods). Conclusions: The findings suggest that rates of rehospitalization remain unacceptably high even 10 years post-injury. The fluctuations in reasons for rehospitalization over this time period may inform intervention and prevention efforts for TBI survivors. The frequency of rehospitalization for general health reasons suggests that long-term health management interventions may be particularly important for this population. Key Words: Brain Injuries, Outcome Assessment (Health Care), Delivery of Health Care, Patient Readmission Disclosure(s): None. Oral Presentation 3967 Biopsychosocial Outcomes in the First Year after Traumatic Brain Injury: Behavior, Depressive Symptoms, and Self-Perception Shannon B. Juengst (University of Pittsburgh), Patricia M. Arenth, Amy Wagner Objective(s): To investigate relationships among behavior, depressive symptoms, self-perception, cognition, and Activity Limitations after traumatic brain injury (TBI). Design: An inception cohort of adults with moderate to severe TBI. Setting: Participants were recruited from an acute medical facility and followed as they returned to the community. Participants: 63 participants with moderate to severe TBI recruited through multiple studies (nZ47 at 6 months, nZ46 at 12 months). Inclusion: Documented TBI; Complete data for all measures. Interventions: N/A. Main Outcome Measure(s): The outcome measures are: Behavior (Frontal Systems Behavior Scale), Depressive Symptoms (Patient Health Questionnaire-9), Self-Perception (Percent Back to Normal, a measure of the self-perceived return to pre-injury functioning), Cognition (Neuropsychological Test Battery), and activity limitations (Functional Independence Measure). Results: Behavior, Depressive Symptoms, Self-Perception, and Activity Limitations were all highly correlated with each other (r>.30, p<.05) at 6 and 12 months, while Cognition was only significantly associated with Activity Limitations at 6 and 12 months and Self-Perception at 6 months.