Readmission to the acute care unit and functional outcomes in patients with severe brain injury during rehabilitation

Domenico Intiso, Andrea Fontana, Giuseppe Maruzzi, Maurizio Tolfa, Massimiliano Copetti, Filomena Dirienzo

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Medical and surgical complications are common after brain lesions and may require acute care unit readmission (ACUR) during the rehabilitation stay. This clinical phenomenon has not been explored in subjects with severe brain injury (sBI). AIM: Because sBIpatients come from the intensive care unit (ICU), patients may be transferred to rehabilitation before complete clinical stabilization. We investigated ACURand causes as well as whether those who required ACURhad different functional outcomes. DESIGN: Prospective cohort study. SETTING: Dedicated rehabilitation setting. PARTICIPANTS: Adult subjects with sBIcausing a disorder of consciousness graded 3-8 on the Glasgow Coma Scale admitted to a dedicated rehabilitative setting were prospectively enrolled from January 2014 to December 2015. METHODS: Functional outcome was investigated using the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), in subjects with and without ACUR, at admission and discharge. Mortality and length of stay (LOS) were recorded. RESULTS: One hundred-thirty (53 F, 77 M; mean age: 55.7±17.8) subjects were admitted to the rehabilitation setting, and 97 were enrolled (43 F, 54 M; mean age: 54.7±18.2). Thirty-six ACURwere detected that involved 29 (29.8%) patients. There were 20 and 16 referrals to acute medical and surgical care, respectively. Significant functional outcomes in all assessment measures were observed after rehabilitation, but subjects without ACUR showed significant improvement in all measurements: LCF (P=0.001), DRS (P<0.001), GOS (P=0.003), and mRS (P<0.001), compared to those who required ACUR. At baseline, patients with ACUR were more disabled than those without ACUR, and they had significant lower LCF scores: 2.60 (95% CI: 2.15-3.14) and 3.47 (95% CI: 3.07-3.91) (P=0.013), respectively. Significant longer LOS was observed in subjects with ACURas compared to those without ACUR: 120 (q1-q3:93-165) vs. 63 (q1-q3: 38-93) days (P<0.001), respectively. The intra-hospital mortality rate was higher in patients who required ACUR(8.1 events per 100 person-months) as compared to those who did not require ACUR(2.8 events per 100 person-months). CONCLUSIONS: Readmission to acute care was common in subjects with sBIduring rehabilitation. Subjects who required ACURhad poorer functional outcomes, higher risk of mortality and longer LOSthan subjects without ACUR. CLINICALREHABILITATIONIMPACT: Careful control of these subjects and more strict collaboration and communication among physicians on the rehabilitative team are required to plan proper care pathways.

Original languageEnglish
Pages (from-to)268-276
Number of pages9
JournalEuropean Journal of Physical and Rehabilitation Medicine
Volume53
Issue number2
DOIs
Publication statusPublished - Apr 1 2017

Keywords

  • Brain injuries
  • Patient readmission
  • Rehabilitation

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

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