Referral to Rehabilitation After Severe Traumatic Brain Injury

Abstract

Background. After a severe traumatic brain injury (TBI), some patients are discharged home without rehabilitation, although rehabilitation is assumed to improve outcome. Objective. To assess factors that predict referral to rehabilitation following acute care. This study is part of a larger inception cohort study assessing the care network in the Parisian area (France). Methods. Between July 2005 and April 2007, 504 adults with severe TBI (Glasgow Coma Scale score ≤8) were prospectively recruited by mobile emergency services. This study included 254 acute care survivors (80% male, median age 32 years). Data regarding demographics, injury severity, and acute care pathway were collected. The first analysis compared patients referred to a rehabilitation facility with patients discharged to a living place. The second analysis compared patients referred to a specialized neurorehabilitation (NR) facility with patients referred to nonspecialized rehabilitation. Univariate and multivariate statistics were computed. Results. In all, 162 patients (64%) were referred to rehabilitation, 115 (45%) of which were referred to NR and 47 (19%) to nonspecialized rehabilitation. The following factors were significantly predictive of nonreferral to rehabilitation: living alone, a lower income professional category, pretraumatic alcohol abuse, lower TBI severity, and transfer through a nonspecialized medical ward before discharge. Patients referred to specialized NR were significantly younger and from a higher income professional category. Conclusions. These results raise concern regarding care pathways because many patients were discharged to living places, probably without adequate assessment and management of rehabilitation needs. Injury severity and social characteristics influenced discharge destination.

Traumatic brain injury among female offenders in a prison population: results of the FleuryTBI study

“…In France, female prisoners are a few years older than male prisoners (a mean age of 35 vs. 33.4). These characteristics are similar to those usually found in offender populations, but also among populations having sustained a TBI (Godin‐Blandeau, Verdot, & Develay, 2013; Jourdan et al., 2013a, 2013b; Mouquet, 2005; Mouquet et al., 1999; Watson, Stimpson, & Hostick, 2004). According to our findings, cases were significantly older than controls ( p  = .01).…”

“…In France, according to a study performed in 1986 among the general population of the Aquitaine Region, 60% of TBI occurred following RTA and 33% following falls (Tiret et al., 1990). More recently, in the Paris region, the main causes of severe TBI were RTAs (53% of patients) and falls (35%) (Jourdan et al., 2013a). In the same study, violence‐related mechanisms were responsible for 5.4% of severe TBI.…”

“…Among female cases, use of alcohol and regular use of alcohol were significantly more frequent than among female controls ( p  = .01). Alcohol has been clearly identified as a factor responsible for TBI and a complicating factor for rehabilitation (Jourdan et al., 2013a; Walker et al., 2001). In the PariS‐TBI study, 16% of patients who sustained a severe TBI reported preinjury alcohol abuse (Jourdan et al., 2013a).…”

“…Alcohol has been clearly identified as a factor responsible for TBI and a complicating factor for rehabilitation (Jourdan et al., 2013a; Walker et al., 2001). In the PariS‐TBI study, 16% of patients who sustained a severe TBI reported preinjury alcohol abuse (Jourdan et al., 2013a). Moreover, a history of alcohol abuse has been identified as having a significant effect on the decision to refer a patient to a rehabilitation unit or not (Jourdan et al., 2013a, 2013b).…”

“…In the PariS‐TBI study, 16% of patients who sustained a severe TBI reported preinjury alcohol abuse (Jourdan et al., 2013a). Moreover, a history of alcohol abuse has been identified as having a significant effect on the decision to refer a patient to a rehabilitation unit or not (Jourdan et al., 2013a, 2013b). …”