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Physical Medicine and Rehabilitation Consultation: Relationships with Acute Functional Outcome, Length of Stay, and Discharge Planning After Traumatic Brain Injury

Wagner, Amy K. MD; Fabio, Tony PhD; Zafonte, Ross D. DO; Goldberg, Gary MD; Marion, Donald W. MD; Peitzman, Andrew B. MD

American Journal of Physical Medicine & Rehabilitation: July 2003 - Volume 82 - Issue 7 - p 526-536
doi: 10.1097/01.PHM.0000073825.09942.8F
Research Articles: TBI

Wagner AK, Fabio T, Zafonte RD, Goldberg G, Marion DW, Peitzman AB: Physical medicine and rehabilitation consultation: relationships with acute functional outcome, length of stay, and discharge planning after traumatic brain injury. Am J Phys Med Rehabil 2003;82:526–536.

Objective Patients hospitalized with traumatic brain injury comprise a large portion of the population treated at trauma centers, and physiatry consultants evaluate many traumatic brain injury patients in this setting. The purpose of this study was to delineate relationships between physical medicine and rehabilitation consultation in this population and acute functional outcome, length of stay, and discharge planning.

Design Data were obtained for 1866 adult patients hospitalized with nonfatal traumatic brain injury. Functional outcome was determined using a modification of the FIM™. Descriptive and regression analyses were used to determine the relationship of physical medicine and rehabilitation consultation to acute discharge FIM score, length of stay, and discharge disposition.

Results Patients receiving physical medicine and rehabilitation consultation had more severe injuries, lower acute discharge FIM scores, and longer length of stay. However, multivariate analysis showed that earlier (<48 hr after admission) physical medicine and rehabilitation consultation resulted in significantly better FIM scores with transfers (odds ratio, 2.61; 95% confidence interval, 1.06–6.40) and locomotion (odds ratio, 3.54; 95% confidence interval, 1.34–9.32) and a significantly shorter acute length of stay (P = 0.001).

Conclusions Early physical medicine and rehabilitation consultation may positively impact functional status and length of stay for patients with traumatic brain injury during acute hospitalization. Additional work is needed to determine how physical medicine and rehabilitation consultation impacts rehabilitation-specific medical issues, long-term functional outcome, and healthcare costs.

From the Department of Physical Medicine and Rehabilitation (AKW, RDZ, GG), the Department of Neurological Surgery, Center for Injury Research and Control (TF, DWM), and Section of Trauma, Department of Surgery (ABP), University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania.

Supported, in part, by National Institute for Disability and Rehabilitation Research Grant H133P970013-00, and Centers for Disease Control and Prevention Grant CCR310285-07.

All correspondence and requests for reprints should be addressed to: Amy Wagner, MD, Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, 3471 Fifth Avenue, Suite 201, Pittsburgh, PA 15213.

© 2003 Lippincott Williams & Wilkins, Inc.