Rehabilitation pathways and functional independence one year after severe traumatic brain injury

After severe traumatic brain injury (TBI) it is recommended that patients in need of rehabilitation be transferred directly from acute care to specialized rehabilitation. However, recent European cohort studies found a variety of care pathways and delays in admission to rehabilitation after severe TBI.

To study the pathways within rehabilitation services in a Norwegian national cohort with severe TBI and the association to functional independence 12 months post-injury.

Observational prospective multicenter study.

Regional trauma centers.

A total of 163 adults, age 16-85 years, with severe TBI.

The main variables were transfer between acute care and rehabilitation, type of rehabilitation services and functional independence.

75% of the patients had specialized TBI rehabilitation, 11% non-specialized and 14% no in-patient rehabilitation. In total, 48% were transferred directly to specialized rehabilitation from acute units in regional trauma centers. There were no differences in injury severity between patients transferred directly and non-directly, but the direct-transfer patients were younger. At 12 months post-injury, 71% were functionally independent and 90% lived in their home. Younger age, fewer days of ventilation and shorter post-traumatic amnesia were associated with independence. Among patients treated with specialized rehabilitation, direct transfer to rehabilitation was associated with functional independence (OR=4.3, P<0.01).

A direct clinical pathway including specialized rehabilitation in dedicated units was associated with functional independence.

Direct pathways from acute care to sub-acute specialized rehabilitation might prove beneficial to functional status.