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The Value of Trauma Scores: Predicting Discharge after Traumatic Brain Injury

Wagner, Amy Kathleen MD; Hammond, Flora McConnell MD; Grigsby, Jared Hairel MS; Norton, Harry James PhD

American Journal of Physical Medicine & Rehabilitation: May-June 2000 - Volume 79 - Issue 3 - p 235-242
Research Article: Brain Injury
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Objective: To determine the association of acute variables with disposition after acute hospitalization.

Design: Revised Trauma Score (RTS), Injury Severity Score (ISS), and the Combined Trauma Score Injury Severity Score (TRISSRTS) were compared with discharge disposition after acute hospitalization of 378 consecutive patients who sustained a traumatic brain injury (TBI) and were treated at a level 1 trauma center between September 1997 and May 1998.

Results: Logistic regression modeling found TRISSRTS to predict discharge to home with or without home health assistance or inpatient rehabilitation vs. nursing home placement or death. Subsequent modeling, excluding patients who died or went to nursing homes, identified RTS and ISS as predictors of discharge to home with or without home health vs. inpatient rehabilitation. A sensitivity of 97.78% and 93.91% were achieved with these two models when tested on a population of 4,625 patients with TBI treated during the last 10 yr at the same facility.

Conclusions: The results suggest that RTS, ISS, and TRISSRTS are predictors of discharge disposition after acute hospitalization with TBI and may be useful measures of rehabilitation services resource planning early in the course of TBI management.

From the Charlotte Institute of Rehabilitation (AKW, FMH) and the Carolinas HealthCare System (JHG, HJN), Charlotte, North Carolina.

Reprints: All correspondence and requests for reprints should be addressed to: Amy Wagner, MD, Charlotte Institute of Rehabilitation, Department of PM&R, 1100 Blythe Blvd., Charlotte NC 28203.

Disclosures: Supported, in part, by Grant H133A-20016 from the National Institute on Disability and Rehabilitation Research, the United States Department of Education, and the Research Enrichment Program for Physiatrists sponsored by a research training grant from the National Institute on Disability and Rehabilitation Research.

Presented at the meeting of the Association of Academic Physiatrists, February 1999.

© 2000 Lippincott Williams & Wilkins, Inc.