Journal CME October 2024, Predictors of mortality and rehabilitation location in adults with prolonged coma following traumatic brain injury-PM R - 2024 - Cassinat - Predictors of mortality and rehabilitation location in adults with prolonged

PM R - 2024 - Cassinat - Predictors of mortality and rehabilitation location in adults with prolonged

Pdf Summary

This study investigated factors influencing mortality and post-acute care discharge locations in adults experiencing prolonged coma due to traumatic brain injury (TBI). Researchers analyzed data from the National Trauma Data Bank, examining cases between 2008 and 2015 involving patients aged 18 or older with TBI and extended unconsciousness exceeding 24 hours. The study included 6,929 patients, among whom 26.8% died, 47.9% were discharged to rehabilitation facilities, and 25.3% were sent home without services.<br /><br />Significant findings indicated that older patients and those with severe injuries had higher mortality rates and were more likely to be discharged to rehabilitation facilities. Moreover, non-White patients and those without insurance were less likely to be referred to rehabilitation. Comorbidities such as diabetes and congestive heart failure (CHF) significantly increased mortality risks and the likelihood of rehabilitation discharge compared to home discharge without support.<br /><br />The study also highlighted that complications like pneumonia and renal issues heightened the chances of rehabilitation facility discharge. Importantly, the analysis did not find a significant mortality difference based on sex, but emphasized that systematic disparities in outcomes exist related to ethnicity and insurance status. For example, African American and Pacific Islander patients were less likely to access rehabilitation care.<br /><br />These outcomes underline the necessity to address medical and sociodemographic disparities, as they influence recovery and care pathways. By identifying these predictive factors, healthcare providers can better tailor treatment plans and enhance rehabilitation decision-making, potentially improving survival and recovery rates for patients with prolonged coma following TBI. <br /><br />This comprehensive examination suggests that focusing on managing comorbidities, especially diabetes and CHF, could reduce mortality and adverse outcomes. Additionally, it points to a need for policy interventions to enhance equitable access to post-acute rehabilitation services.

Keywords

traumatic brain injury

prolonged coma

mortality factors

post-acute care

rehabilitation discharge

sociodemographic disparities

comorbidities

National Trauma Data Bank

healthcare policy

equitable access