TRAUMATIC BRAIN INJURY 1995

7.AUTHOR Whitlock-J-A-Jr, Hamilton-B-B.
INSTITUTION Northeast Rehabilitation Hospital, Salem, NH 03079, USA.
TITLE Functional outcome after rehabilitation for severe traumatic brain injury.
SOURCE Arch-Phys-Med-Rehabil 1995 Dec, VOL: 76 (12), P: 1103-12, ISSN: 0003-9993.


ABSTRACT

OBJECTIVE:

(1) Define functional status at rehabilitation discharge and follow-up for patients admitted with Functional Independence Measure (FIM) of 18 after traumatic brain injury;

(2) describe patterns of function measured at discharge, rehabilitation lengths of stay and costs, and disposition.

DESIGN:

Retrospective, descriptive study using data from the Uniform Data System for Medical Rehabilitation (UDSMR) dataset.

SETTING:

Acute rehabilitation hospitals and, for follow-up data, variety of settings, from community to long-term care.

PATIENTS:

328 patients with rehabilitation admission FIM of 18 (principal impairment group "Brain Dysfunction, Traumatic") drawn from 5,430 TBI patients entered into the data set during 1989-1991. Excluded were 22 persons readmitted to rehab, 5 deaths, 1 case without recorded disposition, and 49 cases without ICD-9 code consistent with brain trauma.

MAIN OUTCOME MEASURES:

FIM scores at rehab discharge and follow-up; disposition; length of stay; cost.

RESULTS:

(1) Mean FIM score at discharge for the group overall (n = 328) was 53 (median = 42 with interquartile range of 18 to 87);

(2) 7.6% had functional scores consistent with independence in motor areas measured by FIM;

(3) 2.7% had functional scores consistent with independence in cognitive areas measured by FIM;

(4) 26.1% showed no change in FIM score between admission and discharge;

(5) 53% were discharged to community settings, 25% to long-term care, 11% to acute facilities, and 11% to other rehab facilities;

(6) average length of stay in acute rehab was 110 days (SD = 70.9, median = 99 days, interquartile range = 57 to 153 days);

(7) average rehabilitation charges (n = 322) were $110,891;

(8) for those with follow-up data (n = 59), average FIM score was 79 (median, 90); 24% were in school and 5% worked in sheltered workshops.

CONCLUSIONS:

(1) Even the most severely disabled persons admitted to acute rehabilitation after traumatic brain injury can show a large degree of measurable functional improvement;

(2) while about 25% of patients showed no measured FIM change, some showed dramatic degrees of functional recovery;

(3) most common discharge setting was home (and community). Author.

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