A retrospective study of 251 patients admitted to a multidisciplinary, neurorehabilitation unit with intensive care unit capabilities

Kjeldsen, Simon Svanborg; Søndergaard, Søren; Mikkelsen, Lone Ramer; Nielsen, Jørgen Feldbæk

doi:10.1080/09638288.2018.1501772

Cited by 4 publications

(7 citation statements)

References 13 publications

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“…The hospital has a nationwide catchment area, and patients may be admitted once the neurosurgical treatment of the primary and secondary injuries is completed, to such a degree that complications are deemed unlikely. 11 Rehabilitation starts at early levels of recovery and is provided by interdisciplinary teams of occupational therapists, physiotherapists, nurses, and auxiliary nurses, with close involvement from physicians, neuropsychologists, speech language therapists, and dieticians. 11,12 In Denmark, dysphagia, and therefore decannulation of patients suffering from severe dysphagia, is primarily managed by occupational therapists, in close collaboration with physicians and the rest of the multidisciplinary team.…”

Section: Rehabilitation Settingmentioning

confidence: 99%

“…15 The EFA is an appropriate assessment tool for functional level in patients with severe disabilities because it is more sensitive to changes in these subjects than the Functional Independence Measure, which is more appropriate for patients with moderate to mild disabilities. 11,16,17 The EFA was scored within 72 h from admission to rehabilitation and every fourth week by an interdisciplinary team consisting of occupational therapists, physiotherapists, nurses, and auxiliary nurses. 16,17 The EFA was developed in Germany and is also used in Denmark 16 and Norway.…”

Section: Clinical Predictorsmentioning

confidence: 99%

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Using Routinely Gathered Clinical Data to Develop a Prognostic Online Tool for Decannulation in Subjects With Acquired Brain Injury

Mortensen¹,

Kjeldsen²,

Honoré³

et al. 2020

Respir Care

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BACKGROUND: Clinicians are often required to provide a qualified guess on the probability of decannulation in estimating patients' rehabilitation potential and relaying information about prognosis to patients and next of kin. The objective of this study was to use routinely gathered clinical data to develop a prognostic model of time to decannulation in subjects with acquired brain injury, for direct implementation in clinical practice. METHODS: Data from a large cohort including 574 tracheostomized subjects admitted for neurorehabilitation were analyzed using discrete time-to-event analysis with logit-link. Within this model, a reference hazard function was modeled using restricted cubic splines, and estimates were presented using odds ratios (95% CIs). RESULTS: A total of 411 subjects (72%) were decannulated within a median of 27 d (interquartile range 16-49) at the rehabilitation hospital. The prognostic model for decannulation included age, diagnosis, days from injury until admission for rehabilitation, swallowing, and overall functional level measured with the Early Functional Abilities score. Among these, the strongest predictors for decannulation were age and a combination of overall functional abilities combined with swallowing ability. CONCLUSIONS: A prognostic model for decannulation was developed using routinely gathered clinical data. Based on the model, an online graphical user interface was applied, in which the probability of decannulation within x days is calculated along with the statistical uncertainty of the probability. Furthermore, a layman's interpretation is provided. The online tool was directly implemented in clinical practice at the rehabilitation hospital, and is available through this link: (

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Section: Rehabilitation Settingmentioning

confidence: 99%

Section: Clinical Predictorsmentioning

confidence: 99%

Using Routinely Gathered Clinical Data to Develop a Prognostic Online Tool for Decannulation in Subjects With Acquired Brain Injury

Mortensen¹,

Kjeldsen²,

Honoré³

et al. 2020

Respir Care

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“…NISU is a rather unique organisation in the context of a Danish hospital. Although physically located at Silkeborg Regional Hospital, NISU is an outstation of the established neuro hospital, HNC [8,22]. NISU is an intermediate hospital station balancing activities of life-saving intensive care treatment and life-making neurorehabilitation.…”

Section: The Context: An Intermediate Hospital Stationmentioning

confidence: 99%

“…Many patients admitted to NISU have reduced respiratory function and have lost their ability to swallow and are in need of mechanical ventilation [8]. In order to secure their airways and prevent lung infections, many patients have a so-called "cuffed tracheostomy tube".…”

Section: The Context: An Intermediate Hospital Stationmentioning

confidence: 99%

“…Nevertheless, 47 days later, Lars is ready to move to the Early Clinic, HNC. Similarly to Lars, around 80 percent of NISU patients are transferred to the Early Clinic [8], meaning that they are circulatory and respiratory stable. This reduced group of patients will continue to train their cognitive and functional abilities in a programme of highly specialised rehabilitation.…”

Section: Plos Onementioning

confidence: 99%

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The temporality of uncertainty in decision-making and treatment of severe brain injury

et al. 2020

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The aim of the study is to investigate how time and uncertainties of clinical action and decision-making plays out in the practical work of early neurorehabilitation in order to present new analytical ways to understand the underlying logics and dynamic social processes that take place during professional treatment of patients with severe acquired brain injury. Drawing on ethnographic fieldwork in a Danish neuro-intensive step-down unit (NISU) specialising in early neurorehabilitation, we found that negotiation of futures takes place in the modern ICU in the present by strategically building upon past experiences. We have argued that the clinical programme therefore cannot be understood only from a "here and now perspective", since the early neurorehabilitation practice is embedded in overlapping temporalities of the past, the present, and desired futures. The study discusses the underlying logics-often hidden or unnoticed-that impact clinical practice of early neurorehabilitation, in what we have termed a logic of clinical reenactment, a logic of future negotiation and a logic of paradox.

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Subacute prognosis of oral nutrition (SPOON): Development of a multivariable prognostic model for complete oral intake in tube-fed subjects with acquired brain injury

Fabricius¹,

Pedersen²

2023

Clinical Nutrition

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A retrospective study of 251 patients admitted to a multidisciplinary, neurorehabilitation unit with intensive care unit capabilities

Cited by 4 publications

References 13 publications

Using Routinely Gathered Clinical Data to Develop a Prognostic Online Tool for Decannulation in Subjects With Acquired Brain Injury

Using Routinely Gathered Clinical Data to Develop a Prognostic Online Tool for Decannulation in Subjects With Acquired Brain Injury

The temporality of uncertainty in decision-making and treatment of severe brain injury

Subacute prognosis of oral nutrition (SPOON): Development of a multivariable prognostic model for complete oral intake in tube-fed subjects with acquired brain injury

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