Functional recovery and mortality after intensive inpatient rehabilitation for severe acquired brain injury in older adults: a retrospective cohort study.
Valeria Pingue, Chiara Pavese, Jasmine Invernizzi Descalzi and 4 others
PMID 42756376WHAT IT FOUND
Older adults after severe acquired brain injury who had swallowing problems and diabetes at admission had poorer function at discharge.
Death during inpatient rehabilitation was more common in older patients.
Key findings
01Among patients aged 65 years or older, dysphagia at admission was associated with worse functional outcomes at discharge on both the Functional Independence Measure and the Glasgow Outcome Scale-extended.
02Diabetes mellitus at admission was independently associated with worse discharge Functional Independence Measure scores in the older group.
03Death during inpatient rehabilitation was significantly more frequent in patients aged 65 years or older than in younger patients.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was retrospective and single-center, so the associations may not apply to other hospitals or patients. Data came from electronic medical records, and some relevant clinical and functional variables were unavailable. Dysphagia was diagnosed by a speech therapist but severity was not standardized, so the study could not measure how severe swallowing problems were. Dysphagia, invasive devices, hospital-acquired pneumonia, and sepsis may reflect overall clinical severity rather than independently causing worse outcomes. The analysis adjusted for brain injury severity and other baseline factors, but residual confounding remains possible. The older subgroup was 91 patients, so subgroup estimates may be unstable. This was not a treatment trial, so it cannot show that any rehabilitation component caused better or worse outcomes.
Declared interests
The work was partially supported by the Italian Ministry of Health under Ricerca Corrente funding to Istituti Clinici Scientifici Maugeri IRCCS. The authors declared financial support for the work or its publication.
The easy way to misread this
Do not read the almost threefold mortality risk with hospital-acquired pneumonia as proof that preventing pneumonia will reduce death. This retrospective cohort found an association, and pneumonia may mark patients who were already more severely injured.