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Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0000000000000050
Original Article: PDF Only

Associations Between Care Pathways and Outcome 1 Year After Severe Traumatic Brain Injury.

Godbolt, Alison K. MD, MBChB; Stenberg, Maud MD; Lindgren, Marie MD; Ulfarsson, Trandur MD; Lannsjö, Marianne MD, PhD; Stålnacke, Britt-Marie MD, PhD; Borg, Jörgen MD, PhD; DeBoussard, Catharina Nygren MD, PhD

Published Ahead-of-Print
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Abstract

Objective: To assess associations between real-world care pathways for working-age patients in the first year after severe traumatic brain injury and outcomes at 1 year.

Setting and Design: Prospective, observational study with recruitment from 6 neurosurgical centers in Sweden and Iceland. Follow-up to 1 year, independently of care pathways, by rehabilitation physicians and paramedical professionals.

Participants: Patients with severe traumatic brain injury, lowest (nonsedated) Glasgow Coma Scale score 3 to 8 during the first 24 hours and requiring neurosurgical intensive care, age 18 to 65 years, and alive 3 weeks after injury.

Main Measures: Length of stay in intensive care, time between intensive care discharge and rehabilitation admission, outcome at 1 year (Glasgow Outcome Scale Extended score), acute markers of injury severity, preexisting medical conditions, and post-acute complications. Logistic regression analyses were performed.

Results: A multivariate model found variables significantly associated with outcome (odds ratio for good outcome [confidence interval], P value) to be as follows: length of stay in intensive care (0.92 [0.87-0.98], 0.014), time between intensive care discharge and admission to inpatient rehabilitation (0.97 [0.94-0.99], 0.017), and post-acute complications (0.058 [0.006-0.60], 0.017).

Conclusions: Delays in rehabilitation admission were negatively associated with outcome. Measures to ensure timely rehabilitation admission may improve outcome. Further research is needed to evaluate possible causation.

(C) 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

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