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Journal of Head Trauma Rehabilitation:
doi: 10.1097/HTR.0000000000000050
Original Articles

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

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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.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


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