Abstract
BackgroundPopulation-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. Linkage of routinely collected administrative health data may provide an efficient alternative. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units).MethodsThis is an observational study using routinely collected registry data (New South Wales Trauma Registry linked with the Australasian Rehabilitation Outcomes Centre Inpatient Dataset). The study cohort includes 268 road trauma patients who were admitted to trauma services between 2009 and 2012 and received inpatient rehabilitation because of a brain injury.ResultsOf those who need inpatient rehabilitation, 62% (n = 166) were admitted to specialist units with the remainder (n = 102) admitted to non-specialist units. Those admitted to a specialist units were younger (p < 0.001), had a lower cognitive FIM score (p = 0.003) on admission than those admitted to non-specialist units. Specialist units achieved better overall FIM score improvements from admission to discharge (43 vs 30 points, p > 0.001) but at a cost of longer length of stay (median 47 vs 24 days, p < 0.001). There were very few discharges to residential aged care facilities from rehabilitation (2% in non-specialist units and none from specialist units). There was a long time lag between trauma and admission to inpatient rehabilitation with only a quarter of the patients admitted to a specialist unit by end of week four. Few older patients (19%) with brain injury were admitted to specialist units.ConclusionsIt is feasible to use routinely collected registry data to monitor inpatient rehabilitation outcomes of trauma care. There were differences in characteristics and outcomes of patients with traumatic brain injury admitted to specialist units compared with non-specialist units.
Highlights
Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive
When faced with limited access to brain injury units, it is conceivable that rehabilitation physicians and geriatricians may consider discharging confused or wandering older brain injury survivors to dementia-specific aged care facilities
This is because general rehabilitation units are often not suitable for this group of patients who are at risk of absconding
Summary
Population-based patterns of care studies are important for trauma care but conducting them is expensive and resource-intensive. The aims of this study are to describe the rehabilitation pathway for trauma survivors and to analyse the brain injury rehabilitation outcomes in the two care settings (specialist brain injury and non-specialist general rehabilitation units). About half of road trauma survivors have a traumatic brain injury [2]. While there is a lack of well-designed experimental studies, the available evidence strongly supports the effectiveness of brain injury rehabilitation in order to maximise the patient’s function [3,4,5,6]. The elements of the continuum of care are three fold: (1) admission under designated trauma services (usually involving neurosurgery), (2) consultation by rehabilitation services for those requiring inpatient rehabilitation and (3) transfer to a rehabilitation unit when medically stable
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