title: Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury.
abstract: 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).
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Rehabilitation Hospital of Indiana, Indianapolis, IN 46254, USA. jmalec@rhin.com
authors.forename: James F
authors.initials: JF
authors.lastname: Malec
authors.forename: Jayawant N
authors.initials: JN
authors.lastname: Mandrekar
authors.forename: Allen W
authors.initials: AW
authors.lastname: Brown
authors.forename: Anne M
authors.initials: AM
authors.lastname: Moessner
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000647:Amnesia / Q000175:diagnosis*; D001930:Brain Injuries / Q000175:diagnosis* / Q000534:rehabilitation*; D003657:Decision Making; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment