Factors Associated with Unsuccessful Admissions to Inpatient Rehabilitation Facilities Among Older Adults With Traumatic Brain Injury

Background: In addition to lowering lipids, statins also may be beneficial for older adults sustaining a traumatic brain injury (TBI), as statin use prior to and following trauma may decrease mortality following injury. However, despite statins’ potential to reduce mortality, there is limited research regarding statin use among older adults. Objective: To characterize and investigate factors associated with statin use among older adults with TBI. Methods: A retrospective drug utilization study was used to characterize statin use among Medicare beneficiaries 65 and older hospitalized with a TBI during 2006 to 2010 and with continuous Medicare Parts A, B, and D coverage 6 months prior and 12 months following TBI. Logistic regression was used to investigate the factors associated with statin use. The exposure of interest was statin use prior to and following TBI. Results: Of the 75 698 beneficiaries included in the study, 37 874 (~50%) of beneficiaries used a statin at least once during the study period. The most common statin used was simvastatin, while fluvastatin was the least used statin. Statin users were more likely to have cardiovascular diseases when compared to nonusers. Hyperlipidemia was a major factor associated with statin use and had the greatest impact on statin use compared to nonuse (odds ratio = 9.54; 95% confidence interval = 9.07, 10.03). Conclusions: This national sample of older adults with TBI suggests that statins are commonly used. Future studies must next examine the impact of statin use on mortality and secondary injury in order to shape pharmacological therapy guidelines following TBI.

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Predictors of 1-Year Global Outcomes After Traumatic Brain Injury Among Older Adults: A NIDILRR Traumatic Brain Injury Model Systems Study

Journal of Aging and Health ◽

10.1177/0898264318819197 ◽

2019 ◽

Vol 31 (10_suppl) ◽

pp. 68S-96S

Author(s):

Flora M. Hammond ◽

Christina A. Baker-Sparr ◽

Marie N. Dahdah ◽

Kristen Dams-O’Connor ◽

Laura E. Dreer ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Age Groups ◽

Inpatient Rehabilitation ◽

Model Systems ◽

Transitions Of Care ◽

Injury Model ◽

Acute Rehabilitation ◽

The Relationship

Objective: To assess predictors of global function and driving status among older adults (50 years and older) who survived 1 year following inpatient rehabilitation for moderate-to-severe traumatic brain injury (TBI). Methods: Functional status at 1-year post-TBI was determined for 1,845 individuals. The relationship age category to function was studied using associations and predictive modeling. Results: The final model accounted for 34% variance in Glasgow Outcome Scale-Extended (GOS-E) among 60- to 69-year-olds and 70- to 79-year-olds, and 25% variance in 50- to 59-year-olds and 80+-year-olds. FIM Motor at rehabilitation discharge made the greatest contribution to GOS-E variance across all age groups. Inpatient rehabilitation discharge to nursing home or adult home and rehospitalization were associated with a one-level decrease in GOS-E. Alcohol use predicted lower GOS-E among the 70- to 79-year-olds. Gender, ethnicity, and rehospitalizations were negatively associated driving. Discussion: Rehabilitation approaches to older adults with TBI may help maximize function and, thereby, improve later outcomes and decrease rehospitlaizations. Such strategies may include longer and more intensive acute rehabilitation with greater patient engagement and enhanced transitions of care.

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Poster 29: Differing Discharge FIM Rating Value for Classifying Return to the Community of Older Adults Receiving Inpatient Rehabilitation Following a Traumatic Brain Injury

Archives of Physical Medicine and Rehabilitation ◽

10.1016/j.apmr.2010.07.055 ◽

2010 ◽

Vol 91 (10) ◽

pp. e13

Author(s):

Timothy Reistetter ◽

Gary Seale ◽

Anne Deutsch ◽

Sam Markello ◽

Carl Granger ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Inpatient Rehabilitation

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Factors associated with receipt of intracranial pressure monitoring in older adults with traumatic brain injury

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2021-000733 ◽

2021 ◽

Vol 6 (1) ◽

pp. e000733

Author(s):

Mira Ghneim ◽

Jennifer Albrecht ◽

Karen Brasel ◽

Ariel Knight ◽

Anna Liveris ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Intraventricular Hemorrhage ◽

Intracranial Pressure Monitoring ◽

Skull Fractures ◽

Pressure Monitoring ◽

Factors Associated ◽

Gcs Score

BackgroundThe Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) include intracranial pressure monitoring (ICPM), yet very little is known about ICPM in older adults. Our objectives were to characterize the utilization of ICPM in older adults and identify factors associated with ICPM in those who met the BTF guidelines.MethodsWe analyzed data from the American Association for the Surgery of Trauma Geriatric TBI Study, a registry study conducted among individuals with isolated, CT-confirmed TBI across 45 trauma centers. The analysis was restricted to those aged ≥60. Independent factors associated with ICPM for those who did and did not meet the BTF guidelines were identified using logistic regression.ResultsOur sample was composed of 2303 patients, of whom 66 (2.9%) underwent ICPM. Relative to Glasgow Coma Scale (GCS) score of 13 to 15, GCS score of 9 to 12 (OR 10.2; 95% CI 4.3 to 24.4) and GCS score of <9 (OR 15.0; 95% CI 7.2 to 31.1), intraventricular hemorrhage (OR 2.4; 95% CI 1.2 to 4.83), skull fractures (OR 3.6; 95% CI 2.0 to 6.6), CT worsening (OR 3.3; 95% CI 1.8 to 5.9), and neurosurgical interventions (OR 3.8; 95% CI 2.1 to 7.0) were significantly associated with ICPM. Restricting to those who met the BTF guidelines, only 43 of 240 (18%) underwent ICPM. Factors independently associated with ICPM included intraparenchymal hemorrhage (OR 2.2; 95% CI 1.0 to 4.7), skull fractures (OR 3.9; 95% CI 1.9 to 8.2), and neurosurgical interventions (OR 3.5; 95% CI 1.7 to 7.2).DiscussionWorsening GCS, intraparenchymal/intraventricular hemorrhage, and skull fractures were associated with ICPM among older adults with TBI, yet utilization of ICPM remains low, especially among those meeting the BTF guidelines, and potential benefits remain unclear. This study highlights the need for better understanding of factors that influence compliance with BTF guidelines and the risks versus benefits of ICPM in this population.Level of evidencePrognostic and epidemiological, level III.

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Functional motor improvement during inpatient rehabilitation among older adults with Traumatic Brain Injury

PM&R ◽

10.1002/pmrj.12644 ◽

2021 ◽

Author(s):

Emily Evans ◽

Cicely Krebill ◽

Roee Gutman ◽

Linda Resnik ◽

Mark R. Zonfrillo ◽

...

Keyword(s):

Older Adults ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Inpatient Rehabilitation ◽

Motor Improvement

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Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2020114 ◽

2021 ◽

Vol 50 (1) ◽

pp. 26-32

Author(s):

Jia Hui Teo ◽

Shu-Ling Chong ◽

LW Chiang ◽

Zhi Min Ng

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Inpatient Rehabilitation ◽

Outpatient Rehabilitation ◽

Accidental Injury ◽

Factors Associated ◽

Traumatic Amnesia ◽

Severity Of Injury ◽

The Cost

ABSTRACT Aim: To evaluate the cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury (TBI). Secondary aim was to identify factors associated with high inpatient rehabilitation cost. Method: Retrospective review of a tertiary hospital’s trauma registry was performed from 2011–2017. All patients aged 16 years or younger who sustained TBI with Glasgow Coma Scale ≤13 were included. Data on patient demographics, mechanism and severity of injury, hospital duration and inpatient rehabilitation cost were collected. We performed a regression analysis to identify factors associated with high rehabilitation cost. Results: There were a total of 51 patients. The median duration of inpatient rehabilitation was 13.5 days (interquartile range [IQR] 4–35), amounting to a median cost of SGD8,361 (IQR 3,543–25,232). Daily ward costs contributed the most to total inpatient rehabilitation cost. Those with severe TBI had longer duration of inpatient rehabilitation that resulted in higher cost of inpatient rehabilitation. Presence of polytrauma, medical complications, post-traumatic amnesia and TBI post-non-accidental injury (NAI) were associated with higher cost of inpatient rehabilitation. Conclusion: The cost of inpatient rehabilitation for paediatric patients post-TBI is significant in Singapore. Patients with TBI secondary to NAI had significantly higher cost of inpatient rehabilitation. Ways to reduce duration of hospitalisation post-TBI and early step-down care or outpatient rehabilitation should be explored to reduce cost. Keywords: Duration, paediatrics, rehabilitative medicine

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