Predicting Institutionalization after Traumatic Brain Injury Inpatient Rehabilitation
Predicting Institutionalization after Traumatic Brain Injury Inpatient Rehabilitation
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DOI：
10.1089/neu.2014.3351
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发表时间：
2015-02-15
影响因子：
4.2
通讯作者：
Glenn, Mel B.
中科院分区：
文献类型：
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作者：
Eum, Regina S.;Seel, Ronald T.;Glenn, Mel B.
创伤性脑损伤(TBI)患者住院后康复的危险因素尚未得到很好的研究，需要更好地了解以指导临床医生进行康复。我们的目标是开发一个预后模型，可以在住院康复机构入院时使用，以预测出院倾向。该模型可用于向跨学科团队提供有关患者在住院康复期间需要特别关注的功能和/或生活状况方面的信息，如果要避免制度化的话。研究人群包括2002-2012年间在创伤性脑损伤模型系统(TBIMS)国家数据库中登记的7219名中重型颅脑损伤患者，他们在受伤前没有被制度化。基于其他人群中的制度化预测因素，我们假设，在受伤之前住在私人住宅的人中，在运动、床椅-轮椅转移、膀胱和肠道控制、进食和入院时对住院康复计划的理解方面更大的依赖将预测出院时的制度化。采用Logistic回归分析，对人口统计学因素进行了调整，对脑外伤严重程度和急性护理住院时间进行了替代测量。C-统计量和预测性曲线验证了五变量模型。在入院时，膀胱管理(调整后的优势比[OR]，0.88；95%CI为0.83，0.93)、床-椅-轮椅转移(OR，0.81[95%CI，0.83-0.93])和理解力(OR，0.78[95%CI，0.68，0.89])的独立性水平越高，出院时住院的风险越低。年龄每增加10年，住院风险增加1.38倍(95%CI，1.29，1.48)，独居风险增加2.34倍(95%CI，1.86，2.94)。C-统计量为0.780。我们的结论是，这个简单的模型可以预测脑外伤患者住院康复后住院的风险。
Risk factors contributing to institutionalization after inpatient rehabilitation for people with traumatic brain injury (TBI) have not been well studied and need to be better understood to guide clinicians during rehabilitation. We aimed to develop a prognostic model that could be used at admission to inpatient rehabilitation facilities to predict discharge disposition. The model could be used to provide the interdisciplinary team with information regarding aspects of patients' functioning and/or their living situation that need particular attention during inpatient rehabilitation if institutionalization is to be avoided. The study population included 7219 patients with moderate-severe TBI in the Traumatic Brain Injury Model Systems (TBIMS) National Database enrolled from 2002-2012 who had not been institutionalized prior to injury. Based on institutionalization predictors in other populations, we hypothesized that among people who had lived at a private residence prior to injury, greater dependence in locomotion, bed-chair-wheelchair transfers, bladder and bowel continence, feeding, and comprehension at admission to inpatient rehabilitation programs would predict institutionalization at discharge. Logistic regression was used, with adjustment for demographic factors, proxy measures for TBI severity, and acute-care length-of-stay. C-statistic and predictiveness curves validated a five-variable model. Higher levels of independence in bladder management (adjusted odds ratio [OR], 0.88; 95% CI 0.83, 0.93), bed-chair-wheelchair transfers (OR, 0.81 [95% CI, 0.83-0.93]), and comprehension (OR, 0.78 [95% CI, 0.68, 0.89]) at admission were associated with lower risks of institutionalization on discharge. For every 10-year increment in age was associated with a 1.38 times higher risk for institutionalization (95% CI, 1.29, 1.48) and living alone was associated with a 2.34 times higher risk (95% CI, 1.86, 2.94). The c-statistic was 0.780. We conclude that this simple model can predict risk of institutionalization after inpatient rehabilitation for patients with TBI.