Successful Community Discharge Among Older Adults With Traumatic Brain Injury in Skilled Nursing Facilities.
Emily Evans, Roee Gutman, Linda Resnik and 6 others
PMID 33528173WHAT IT FOUND
For older adults with TBI in skilled nursing facilities, discharge home depends on function, not injury severity.
Cognitive impairment, dependence in daily activities, incontinence, and dual Medicare/Medicaid enrollment predict failure to discharge home. Traditional injury scores like GCS do not.
Key findings
01Dual Medicare and Medicaid enrollment was associated with lower adjusted odds of successful discharge (OR 0.47).
02Cognitive impairment and dependence in activities of daily living were associated with lower adjusted odds of successful discharge.
03Injury severity markers, including Glasgow Coma Scale and Abbreviated Injury Scale scores, were not significantly associated with successful discharge.
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 could not account for pre-injury functional status, so it is unclear if deficits observed at SNF admission were caused by the TBI or were pre-existing conditions. The sample was limited to patients from hospitals with burn beds, which may not represent all trauma centers. Results do not generalize to Medicare Advantage enrollees or patients with recent prior institutional care. The study relied on linked data, which carries a risk of linkage errors, although statistical methods were used to account for this.
The easy way to misread this
Do not assume that a patient with a mild Glasgow Coma Scale score will easily discharge home. This study found that injury severity scores were not associated with discharge success, while functional and cognitive status were strong predictors.