Impact of Socioethnic Factors on Outcomes Following Traumatic Brain Injury

Heffernan, Daithi S.; Vera, Roberto M.; Monaghan, Sean F.; Thakkar, Rajan K.; Kozloff, M.; Connolly, Michael D.; Gregg, Shea C.; Machan, Jason T.; Harrington, David; Adams, Charles A.; Cioffi, William G.

doi:10.1097/ta.0b013e31820d0ed7

Cited by 76 publications

(55 citation statements)

References 28 publications

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“…Variables representing patient/injury characteristics and hospital resource usage were grouped for statistical analysis. Patient/injury characteristic variables known to be associated with trauma outcomes included age, [33][34][35] Injury Severity Score (ISS), 16,36 and score on the Glasgow Coma Scale (GCS). 35,37 Number of physiological complications (eg, cardiovascular, gastrointestinal, hematologic, hepatic/pancreatic/ biliary/splenic, infectious, musculoskeletal/integumentary, neurological, pulmonary, renal/genitourinary, vascular), hypothesized to be related to resource usage because of increased complications for obese patients 7,9,[15][16][17][18]24 was also included as an injury factor.…”

Section: Study Variablesmentioning

confidence: 99%

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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Background Allocating resources appropriately requires knowing whether obese patients use more resources during a hospital stay than nonobese patients. Objectives To determine if trauma patients with different body mass indexes differed in use of resources measured as a multifaceted outcome variable. Methods A trauma registry was used for a retrospective study of adult patients admitted to a midwestern level I trauma center. Patients were stratified into 3 groups: nonobese (normal weight, overweight), obese, and morbidly obese. Three canonical correlation analyses were used to determine the relationship between patient/injury characteristics and hospital resource usage. Results In a sample of 9771 patients, 71.2% were non-obese, 23.8% obese, and 5.0% morbidly obese. For patient/injury characteristics, Injury Severity Score and physiological complications were significant variables for all 3 groups. Scores on the Glasgow Coma Scale were significant for nonobese patients only. For resource usage, intensive care unit length of stay and procedures were significant variables for all 3 groups. Conclusions Associations between body mass index and outcomes have been noted when assessed as independent variables. However, when resource usage was assessed as a multifaceted outcome variable, injury factors (higher Injury Severity Score, lower scores on the Glasgow Coma Scale, more physiological complications) were associated with resource usage (increased length of stay in the intensive care unit and increased number of procedures). These findings provide clinicians a new perspective for evaluating the complex relationship between patient/injury characteristics and hospital resource usage.

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Section: Study Variablesmentioning

confidence: 99%

Association of Injury Factors, Not Body Mass Index, With Hospital Resource Usage in Trauma Patients

Lee

Hervey

Berg

et al. 2016

American Journal of Critical Care

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“…Actually, our recruitment procedures had discarded patients with standards of living interfering with the prerequisites of the market of labour. Low fi nancial income tends to worsen clinical outcomes in patients with TBI [34,35]. Nevertheless, all our patients had equal access to medical care facilities and could benefi t from national insurance resources.…”

Section: Discussionmentioning

confidence: 99%

Occupational Reintegration in Patients with Traumatic Brain Injury

Catano¹,

Robert²,

Houa³

et al. 2015

Int J Neurorehabilitation Eng

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. Incidence of TBI varies greatly between studies. As compared to 98/100,000 in USA or to 160/100,000 in India, it has been reported that the annual incidence of TBI was 235/100,000 in Europe with large disparities among countries: 91/100,000 in Italy, 435/100,000 in England or 546/100,000 in Sweden [3][4][5].In Western countries, one person is victim of a TBI every three minutes, which represents 200,000 victims/year from which 50,000 will be hospitalized, 2,800 will die and 5,000 will keep permanent disabilities [6][7][8]. Th ese fi gures do not include the 15,000 accidents of sport per year which are responsible for various behavioral disorders [9,10].In neuro-rehabilitation practice, diff use cerebral lesions, either of hemorrhagic or of traumatic origin, are generally associated with a coma whose initial severity and duration will determine (a) the chances of survival and (b) the degree of the subsequent recovery [11][12][13]. In survivors, the impacts on the cerebral functioning are numerous and complex, aff ecting motor control, sensory modalities, psychointellectual function, language and writing, recognition of the familiar faces, perception of the environment, … Unfortunately, patients will remain in a state of complete functional dependence for the Activities of Daily Life (ADL) in many cases.Neurological rehabilitation aims primarily to promote the return to independence at home, in the society and at work. One of the fundamental missions of our Department of neuro-rehabilitation is to provide adequate neurological and/or cognitive rehabilitation treatments in order to to ensure an optimal integration with a priority for returning to work [14].Our Department has 100 beds specifi cally intended for the neurological treatments of cerebral injuries. Th e daily care starts from the acute phase of the injury until the functional recovery and the return to autonomy. Continuation of the multidisciplinary treatments as ambulatory cares is provided when necessary. In addition, a AbstractThere is little information on the effi ciencies and limits of the professional reintegration models among patients having suffered from a traumatic brain injury (TBI). In order to identify which factors should be taken into account to establish an accurate individual professional reintegration program, we have studied retrospectively the data from 56 consecutive patients having suffered a TBI with initial loss of consciousness. Our results indicate that many patients evidenced cognitive and executive functions disorders with negative impacts upon employment outcomes. In the patients who returned to work after the TBI, professional reintegration was achieved along with social integration process. Socioeconomic status also appears to affect the possibilities of work recovery as patients with lower levels of education and employment showed a poor outcome in returning to work. Among other positive features, young age at the time of the onset and facilities of arrangement of the work conditions tended to be useful for occupational...

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“…The selection of variables for multivariate analyses was based on availability as well as on variables of interest. Patient/injury characteristic variables included BMI (the outcome of interest, shown to be associated with resource usage), 15,20 age (associated with trauma outcomes), 28,29 ISS (shown to be associated with resource usage 17 and trauma outcomes), 28,29 and physiologic complications (a measure of injury severity, which researchers hypothesized would be related to resource usage due to increased complications [cardiac and pulmonary] for obese patients). Hospital resource usage variables included ICU LOS and hospital LOS (both of which have been observed in the literature as measures of resource utilization), [21][22][23] medical consults (eg, neurosurgery, orthopedics [to assess "human resources"]), and procedures (eg, computerized axial tomography, splint extremity [to assess "human" and material resources]).…”

Section: Study Variablesmentioning

confidence: 99%