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Distal and Proximal Predictors of Rehospitalization Over 10 Years Among Survivors of TBI: A National Institute on
Kirk Lercher1, Raj G Kumar, Flora M Hammond
1Department of Rehabilitation and Human Performance (Drs Lercher, Kumar, and Dams-O'Connor), Department of Neurology (Dr Dams-O'Connor), and Brain Injury Research Center (Dr Dams-O'Connor), Icahn School of Medicine at Mount Sinai, New York City, New York; Department of Physician Medicine and Rehabilitation, Indiana University School of Medicine and Rehabilitation Hospital of Indiana, Indianapolis (Dr Hammond); Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle (Dr Hoffman); Department of Rehabilitation Medicine, Long School of Medicine at UT Health San Antonio, San Antonio, Texas (Dr Verduzco-Gutierrez); Dept. of Physical Medicine and Rehabilitation (PM&R), School of Medicine, Virginia Commonwealth University (VCU), Richmond (Dr Walker); and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Brigham and Women's Hospital, Harvard Medical School, Boston (Dr Zafonte).
Objective:
To describe the rates and causes of rehospitalization over a 10-year period following a moderate-severe traumatic brain injury (TBI) utilizing the Healthcare Cost and Utilization Project (HCUP) diagnostic coding scheme.
Setting:
TBI Model Systems centers.
Participants:
Individuals 16 years and older with a primary diagnosis of TBI.
Design:
Prospective cohort study.
Main Measures:
Rehospitalization (and reason for rehospitalization) as reported by participants or their proxies during follow-up telephone interviews at 1, 2, 5, and 10 years postinjury.
Results:
The greatest number of rehospitalizations occurred in the first year postinjury (23.4% of the sample), and the rates of rehospitalization remained stable (21.1%-20.9%) at 2 and 5 years postinjury and then decreased slightly (18.6%) at 10 years postinjury. Reasons for rehospitalization varied over time, but seizure was the most common reason at 1, 2, and 5 years postinjury. Other common reasons were related to need for procedures (eg, craniotomy or craniectomy) or medical comorbid conditions (eg, diseases of the heart, bacterial infections, or fractures). Multivariable logistic regression models showed that Functional Independence Measure (FIM) Motor score at time of discharge from inpatient rehabilitation was consistently associated with rehospitalization at all time points. Other factors associated with future rehospitalization over time included a history of rehospitalization, presence of seizures, need for craniotomy/craniectomy during acute hospitalization, as well as older age and greater physical and mental health comorbidities.
Conclusion:
Using diagnostic codes to characterize reasons for rehospitalization may facilitate identification of baseline (eg, FIM Motor score or craniotomy/craniectomy) and proximal (eg, seizures or prior rehospitalization) factors that are associated with rehospitalization. Information about reasons for rehospitalization can aid healthcare system planning. By identifying those recovering from TBI at a higher risk for rehospitalization, providing closer monitoring may help decrease the healthcare burden by preventing rehospitalization.
