Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury

James F. Malec, Jayawant N. Mandrekar, Allen W. Brown, Anne M. Moessner

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Primary objective: To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). Research design: A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Main outcomes and results: Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Conclusions: Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

Original languageEnglish (US)
Pages (from-to)22-29
Number of pages8
JournalBrain Injury
Volume23
Issue number1
DOIs
StatePublished - 2009

Fingerprint

Aptitude
Amnesia
Skilled Nursing Facilities
Wounds and Injuries
Inpatients
Rehabilitation
Nurse Clinicians
Therapeutics
Social Adjustment
Documentation
Decision Making
Research Design
Logistic Models
Regression Analysis
Demography
Traumatic Brain Injury
Equipment and Supplies

Keywords

  • Brain Injury
  • Medical decision-making
  • Rehabilitation

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury. / Malec, James F.; Mandrekar, Jayawant N.; Brown, Allen W.; Moessner, Anne M.

In: Brain Injury, Vol. 23, No. 1, 2009, p. 22-29.

Research output: Contribution to journalArticle

Malec, James F. ; Mandrekar, Jayawant N. ; Brown, Allen W. ; Moessner, Anne M. / Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury. In: Brain Injury. 2009 ; Vol. 23, No. 1. pp. 22-29.
@article{4520d74cf1174b7aadea21db0cc7ce41,
title = "Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury",
abstract = "Primary objective: To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). Research design: A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Main outcomes and results: Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7{\%} of the sample; ratings on the Ability Index alone were associated with this decision in 92.2{\%} of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64{\%} of cases. Conclusions: Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.",
keywords = "Brain Injury, Medical decision-making, Rehabilitation",
author = "Malec, {James F.} and Mandrekar, {Jayawant N.} and Brown, {Allen W.} and Moessner, {Anne M.}",
year = "2009",
doi = "10.1080/02699050802590320",
language = "English (US)",
volume = "23",
pages = "22--29",
journal = "Brain Injury",
issn = "0269-9052",
publisher = "Informa Healthcare",
number = "1",

}

TY - JOUR

T1 - Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury

AU - Malec, James F.

AU - Mandrekar, Jayawant N.

AU - Brown, Allen W.

AU - Moessner, Anne M.

PY - 2009

Y1 - 2009

N2 - Primary objective: To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). Research design: A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Main outcomes and results: Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Conclusions: Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

AB - Primary objective: To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). Research design: A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Main outcomes and results: Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Conclusions: Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

KW - Brain Injury

KW - Medical decision-making

KW - Rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=59249109338&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=59249109338&partnerID=8YFLogxK

U2 - 10.1080/02699050802590320

DO - 10.1080/02699050802590320

M3 - Article

C2 - 19096971

AN - SCOPUS:59249109338

VL - 23

SP - 22

EP - 29

JO - Brain Injury

JF - Brain Injury

SN - 0269-9052

IS - 1

ER -