Characteristics of Individuals with Moderate-to-Severe Traumatic Brain Injury and Predictors of Specialized Rehabilitation: A Retrospective Cohort Study

Abstract

Purpose: Traumatic brain injury (TBI) is a disabling neurological condition that can cause substantial cognitive, behavioural, and physical health problems for the individual. Currently, it is a leading cause of death for Canadians. Rehabilitation (particularly specialized rehabilitation) has been shown to promote recovery in those with moderate-to-severe TBI, but not all eligible candidates receive it. We aim to 1) investigate demographic and clinical characteristics of individuals with moderate-to-severe TBI discharged to rehabilitation within 1-year post-injury over a 7-year period, and 2) identify predictors of discharge to specialized rehabilitation for these individuals. Materials and Methods: Patient characteristics were examined by linking their unique health insurance number through databases. Predictors of specialized rehabilitation were determined using logistic regression models. Results: Of 25,095 individuals with moderate-to-severe TBI, 4,748 individuals were admitted to rehabilitation within 365 days of injury between years 2010/2011 and 2017/2018. Most individuals who were admitted to rehabilitation were 64 years old or older (60%). Majority were male (65.6%). The most common cause of injury was related to a fall (61.7%). 13.9% of individuals had a mental health condition at the time of TBI hospitalization. 72.1% were discharged directly to rehabilitation following acute discharge. Mean wait time to rehabilitation was 37.3 (±52.5) days. 7.2% were rehospitalized immediately following rehabilitation discharge. Younger age, male sex, and higher rurality were some significant predictors of receiving specialized rehabilitation. Repatriated patients were less likely to receive specialized rehabilitation. Conclusion: This study identifies key healthcare utilization characteristics of individuals with moderate-to-severe TBI, as well as significant predictors of discharge to specialized rehabilitation for this population. We also highlight potential future research areas relating to these trends. This knowledge will be useful for policy planners and administrators who wish to improve patient access to care, appropriateness of care, and outcomes following moderate-to-severe TBI.