Variation in Adult Traumatic Brain Injury Outcomes in the United States.
Nathaniel H Greene, Mary A Kernic, Monica S Vavilala and 1 others
PMID 28422899WHAT IT FOUND
Adults hospitalized with traumatic brain injury in 20 US states showed large differences in survival and access to inpatient rehabilitation depending on where they received care.
Uninsured patients were more likely to die and less likely to receive rehabilitation than those with insurance.
Key findings
01Inpatient mortality varied significantly by state, ranging from 9.8% in California to 13.5% in North Carolina.
02The proportion of patients discharged to inpatient rehabilitation varied widely by state, from 5.6% in Oregon to 19.7% in Massachusetts.
03Uninsured patients were approximately 13% more likely to die in the hospital and 0.35 times as likely to be discharged to inpatient rehabilitation compared to insured 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 only analyzed data from 20 states in 2010, representing about half the US adult population, so results may not apply to other states or more recent years. The dataset did not include information on race, comorbidities, or the specific treatments provided in the hospital, so these factors could explain some of the differences. California was excluded from the rehabilitation analysis because its data did not distinguish between discharge to a rehabilitation hospital and a skilled nursing facility. The study assumed that TBI severity was similar across states, which may not be true, and it could not account for pre-hospital care differences or emergency department practices. It did not distinguish between patients discharged home with outpatient therapy or home health care versus those discharged home with no services.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not assume that the variation in outcomes is due to differences in clinical quality or rehabilitation effectiveness. The study shows where patients ended up, not how well they were treated. The variation could be driven by state policies on bed availability, insurance coverage, or pre-hospital care, rather than the skill of the therapists or the quality of the rehabilitation programs.