Longitudinal Trends in Severe Traumatic Brain Injury Inpatient Rehabilitation.
Alissa A Totman, Adam G Lamm, Richard Goldstein and 5 others
PMID 36730991WHAT IT FOUND
Fewer of the most severely disabled traumatic brain injury patients entered inpatient rehabilitation, and their stays shortened.
Patients were older, and payer mix shifted toward Medicare.
Key findings
01The number of most severely disabled traumatic brain injury patients discharged from inpatient rehabilitation each year fell from 649 to 488, and their share of patients with traumatic brain injury fell from 5.5% to 2.5%.
02Mean rehabilitation length of stay fell by 12.2 days, from 41.5 days to 29.3 days.
03Mean age rose from 43.0 years to 53.7 years, Medicare patients rose from 21.3% to 43.2%, and commercially insured patients fell from 42.7% to 24.8%.
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 database did not include injury severity, Glasgow Coma Scale score, days of post-traumatic amnesia, specific medical diagnosis, or injury cause. The study included only patients already admitted to inpatient rehabilitation, so it cannot show how many severe traumatic brain injury patients died, were treated elsewhere, or were discharged directly home from acute care. Patients who died or left against medical advice were excluded, so outcomes for those patients are missing. The study reports trends over time, not whether shorter stays or fewer admissions caused worse recovery. The database covered over 70% of inpatient rehabilitation facilities in the United States, not all facilities.
Declared interests
Funding declarations list NIH, NIDILRR, Administration for Community Living, James S. McDonnell Foundation, Tiny Blue Dot Foundation, Shriners Hospitals for Children, Department of Defense, Mediwound, and TBI Model Systems; no conflicts or funding were declared for the remaining authors.
The easy way to misread this
Do not conclude that shorter rehabilitation stays caused worse outcomes. The paper reports national trends and cannot separate the effects of admission, length of stay, payer change, or patient severity on recovery.