title: Physical medicine and rehabilitation consultation: relationships with acute functional outcome, length of stay, and discharge planning after traumatic brain injury.
abstract: OBJECTIVE
  Patients hospitalized with traumatic brain injury comprise a large portion of the population treated at trauma centers, and physiatry consultants evaluate many traumatic brain injury patients in this setting. The purpose of this study was to delineate relationships between physical medicine and rehabilitation consultation in this population and acute functional outcome, length of stay, and discharge planning.
  
  
  METHODS
  Data were obtained for 1866 adult patients hospitalized with nonfatal traumatic brain injury. Functional outcome was determined using a modification of the FIM trade mark. Descriptive and regression analyses were used to determine the relationship of physical medicine and rehabilitation consultation to acute discharge FIM score, length of stay, and discharge disposition.
  
  
  RESULTS
  Patients receiving physical medicine and rehabilitation consultation had more severe injuries, lower acute discharge FIM scores, and longer length of stay. However, multivariate analysis showed that earlier (<48 hr after admission) physical medicine and rehabilitation consultation resulted in significantly better FIM scores with transfers (odds ratio, 2.61; 95% confidence interval, 1.06-6.40) and locomotion (odds ratio, 3.54; 95% confidence interval, 1.34-9.32) and a significantly shorter acute length of stay (P = 0.001).
  
  
  CONCLUSIONS
  Early physical medicine and rehabilitation consultation may positively impact functional status and length of stay for patients with traumatic brain injury during acute hospitalization. Additional work is needed to determine how physical medicine and rehabilitation consultation impacts rehabilitation-specific medical issues, long-term functional outcome, and healthcare costs.
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pennsylvania 15213, USA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Wagner
authors.forename: Tony
authors.initials: T
authors.lastname: Fabio
authors.forename: Ross D
authors.initials: RD
authors.lastname: Zafonte
authors.forename: Gary
authors.initials: G
authors.lastname: Goldberg
authors.forename: Donald W
authors.initials: DW
authors.lastname: Marion
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Peitzman
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008124:Locomotion; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors; D014481:United States