Article

After a severe traumatic brain injury (TBI), some patients are
discharged home without rehabilitation, although rehabilitation is assumed to
improve outcome. OBJECTIVE: To assess factors that predict referral to
rehabilitation following acute care. This study is part of a larger inception
cohort study assessing the care network in the Parisian area (France). METHODS:
Between July 2005 and April 2007, 504 adults with severe TBI (Glasgow Coma Scale
score </= 8) were prospectively recruited by mobile emergency services. This
study included 254 acute care survivors (80% male, median age 32 years). Data
regarding demographics, injury severity, and acute care pathway were collected.
The first analysis compared patients referred to a rehabilitation facility with
patients discharged to a living place. The second analysis compared patients
referred to a specialized neurorehabilitation (NR) facility with patients
referred to nonspecialized rehabilitation. Univariate and multivariate statistics
were computed. RESULTS: . In all, 162 patients (64%) were referred to
rehabilitation, 115 (45%) of which were referred to NR and 47 (19%) to
nonspecialized rehabilitation. The following factors were significantly
predictive of nonreferral to rehabilitation: living alone, a lower income
professional category, pretraumatic alcohol abuse, lower TBI severity, and
transfer through a nonspecialized medical ward before discharge. Patients
referred to specialized NR were significantly younger and from a higher income
professional category. CONCLUSIONS: These results raise concern regarding care
pathways because many patients were discharged to living places, probably without
adequate assessment and management of rehabilitation needs. Injury severity and
social characteristics influenced discharge destination.

Langue : ANGLAIS