Improvement rate of patients with severe brain injury during post-acute intensive rehabilitation.

Abstract

Patients with severe acquired brain injury (SABI) may evolve towards different outcomes. The primary aim was to evaluate the clinical evolution of a large population of patients with SABI admitted to post-acute rehabilitation from 2001 to 2016, diagnosed with severe brain injury (GCS ≤ 8) in the acute phase and a coma duration of at least 24h. The possible changes between the admission time to a post-acute rehabilitation hospital and the discharge time were measured by means of Glasgow Outcome Scale (GOS), Level of Cognitive Functioning (LCF), and Disability Rating Scale (DRS). We also correlated the improvement rate with some sociodemographic and clinical features of the individuals with SABI enrolled. Data of 890 patients were analyzed (54% TBI, length of stay = 162 ± 186days, GCS = 7.46 ± 1.28); time interval from the SABI (OR = 0.246, CI 95% = 0.181-0.333), scores at admission of LCF (OR = 2.243, CI 95% = 1.492-3.73), GOS (OR = 0.138, CI 95% = 0.071-0.266), DRS (OR = 0.457, CI 95% = 0.330-0.632), and etiology (OR = 2.273, CI 95% = 1.676-3.084) played a significant role (p < 0.001, explained variance 69.9%) for improving GOS score. Time interval from the SABI to admission in our post-acute rehabilitation ward (OR = 0.300, CI 95% = 0.179-0.501, p < 0.001), length of rehabilitation stay (OR = 2.808, CI 95% = 1.694-4.653, p < 0.001), and etiology (OR = 1.769, CI 95% = 1.095-2.857, p = 0.020) led to a statistically significant improvement in DRS (explained variance 91%). The most significant predictive factors for the outcome of patients with SABI were etiology, time interval from SABI to admission in rehabilitation, and length of rehabilitation stay.