Citation

Dahdah MN, Barnes S, Amy B, Dubiel R, Dunklin C, Callender L, Harper C, Wilson A, Diaz-Arrastia R, Bergquist T, Sherer M, Whiteneck G, Pretz C, Vanderploeg RD, Shafi S. Arch. Phys. Med. Rehabil. 2016; 97(11): 1821-1831.

Affiliation

North Texas Traumatic Brain Injury Model Systems Center; Baylor Institute for Health Care Research and Improvement, Dallas, TX. Electronic address: shahid.shafi@baylorhealth.edu.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.apmr.2016.05.005

PMID

27246623

Abstract

OBJECTIVE: To compare patient functional outcomes across TBIMS rehabilitation centers using an enhanced statistical model and to determine factors that influence those outcomes. SETTING: Traumatic Brain Injury Model Systems (TBIMS) Centers. PARTICIPANTS: TBI patients admitted to 19 TBIMS rehabilitation centers from 2003 to 2012 (Total N = 5,505).

DESIGN: Multicenter observational cohort study. MAIN OUTCOME MEASURES: Functional outcomes of patients with TBI.

RESULTS: Individuals with lower functional status at the time of admission, longer duration of post-traumatic amnesia (PTA), and higher burden of medical comorbidities continued to have worse functional outcomes at discharge from inpatient rehabilitation and at 1-year follow-up, whereas those who were employed at the time of injury had better outcomes at both time periods. Risk-adjusted patient functional outcomes for patients in most TBIMS centers were consistent with previous research. However, there were wide performance differences for a few centers even after using more recently collected data, improving upon the regression models by adding predictors known to influence functional outcomes, and employing bootstrapping to eliminate confounds.

CONCLUSIONS: Specific patient, injury, and clinical factors are associated with differences in functional outcomes within and across TBIMS rehabilitation centers. However, these factors did not explain all the variance in patient outcomes suggesting a role of some other predictors that remain unknown.

Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Language: en