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Lercher K, Kumar RG, Hammond FM, Zafonte RD, Hoffman JM, Walker WC, Verduzco-Gutierrez M, Dams-O’Connor K. Distal and Proximal Predictors of Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on Disability, Independent Living, and Rehabilitation Research Traumatic Brain Injury Model Systems Study. J Head Trauma Rehabil 2023; 38:203-213. [PMID: 36102607 PMCID: PMC9985661 DOI: 10.1097/htr.0000000000000812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme. SETTING TBI Model Systems centers. PARTICIPANTS Individuals 16 years and older with a primary diagnosis of TBI. DESIGN Prospective cohort study. MAIN MEASURES Rehospitalization (and reason for rehospitalization) as reported by participants or their proxies during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury. RESULTS The greatest number of rehospitalizations occurred in the first year postinjury (23.4% of the sample), and the rates of rehospitalization remained stable (21.1%-20.9%) at 2 and 5 years postinjury and then decreased slightly (18.6%) at 10 years postinjury. Reasons for rehospitalization varied over time, but seizure was the most common reason at 1, 2, and 5 years postinjury. Other common reasons were related to need for procedures (eg, craniotomy or craniectomy) or medical comorbid conditions (eg, diseases of the heart, bacterial infections, or fractures). Multivariable logistic regression models showed that Functional Independence Measure (FIM) Motor score at time of discharge from inpatient rehabilitation was consistently associated with rehospitalization at all time points. Other factors associated with future rehospitalization over time included a history of rehospitalization, presence of seizures, need for craniotomy/craniectomy during acute hospitalization, as well as older age and greater physical and mental health comorbidities. CONCLUSION Using diagnostic codes to characterize reasons for rehospitalization may facilitate identification of baseline (eg, FIM Motor score or craniotomy/craniectomy) and proximal (eg, seizures or prior rehospitalization) factors that are associated with rehospitalization. Information about reasons for rehospitalization can aid healthcare system planning. By identifying those recovering from TBI at a higher risk for rehospitalization, providing closer monitoring may help decrease the healthcare burden by preventing rehospitalization.
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Affiliation(s)
- Kirk Lercher
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Raj G. Kumar
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai
| | - Flora M. Hammond
- Department of Physician Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis, Indiana
| | - Ross D. Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jeanne M. Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - William C. Walker
- Dept. of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University (VCU), Richmond, VA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine at UT Health San Antonio, San Antonio, Texas
| | - Kristen Dams-O’Connor
- Brain Injury Research Center, Professor, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1163, New York
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Kowalski RG, Haarbauer-Krupa JK, Bell JM, Corrigan JD, Hammond FM, Torbey MT, Hofmann MC, Dams-O'Connor K, Miller AC, Whiteneck GG. Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury: Incidence and Impact on Outcome. Stroke 2017; 48:1802-1809. [PMID: 28611087 DOI: 10.1161/strokeaha.117.017327] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/14/2017] [Accepted: 05/08/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. METHODS A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. RESULTS Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, -16.8 to -9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3-2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1-23.4; P<0.001). CONCLUSIONS Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events.
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Affiliation(s)
- Robert G Kowalski
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.).
| | - Juliet K Haarbauer-Krupa
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Jeneita M Bell
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - John D Corrigan
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Flora M Hammond
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Michel T Torbey
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Melissa C Hofmann
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Kristen Dams-O'Connor
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - A Cate Miller
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
| | - Gale G Whiteneck
- From the Research Department, Craig Hospital, Englewood, CO (R.G.K., M.C.H., G.G.W.); Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA (J.K.H.-K., J.M.B.); Department of Physical Medicine and Rehabilitation (J.D.C.), and Departments of Neuroscience, Neurology and Neurological Surgery, Division of Cerebrovascular Disease and Neurocritical Care (M.T.T.), Ohio State University Wexner Medical Center, Columbus; Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis (F.M.H.); Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY (K.D.-O.); and National Institute on Disability, Independent Living, and Rehabilitation Research, Administration for Community Living, U.S. Department of Health and Human Services (A.C.M.)
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