title: Do rehospitalization rates differ among injury severity levels in the NIDRR Traumatic Brain Injury Model Systems program?
abstract: OBJECTIVE
  To compare the rate and nature of rehospitalization in a cohort of patients enrolled in the National Institute on Disability and Rehabilitation Research Traumatic Brain Injury Model Systems (TBIMS) who have disorders of consciousness (DOC) at the time of rehabilitation admission with those in persons with moderate or severe traumatic brain injury (TBI) but without DOC at rehabilitation admission.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Inpatient rehabilitation within TBIMS with annual follow-up.
  
  
  METHODS
  Of 9028 persons enrolled from 1988 to 2009 (N=9028), 366 from 20 centers met criteria for DOC at rehabilitation admission and follow-up data, and another 5132 individuals met criteria for moderate (n=769) or severe TBI (n=4363).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Participants and/or their family members completed follow-up data collection including questions about frequency and nature of rehospitalizations at 1 year postinjury. For the subset of participants with DOC, additional follow-up was conducted at 2 and 5 years postinjury.
  
  
  RESULTS
  The DOC group demonstrated an overall 2-fold increase in rehospitalization in the first year postinjury relative to those with moderate or severe TBI without DOC. Persons with DOC at rehabilitation admission have a higher rate of rehospitalization across several categories than persons with moderate or severe TBI.
  
  
  CONCLUSIONS
  Although the specific details of rehospitalization are unknown, greater injury severity resulting in DOC status on rehabilitation admission has long-term implications. Data highlight the need for a longitudinal approach to patient management.
authors.affiliation: Division of MHBS, James A. Haley Veterans Hospital, Tampa, FL; Center of Excellence for Maximizing Rehabilitation Outcomes, Tampa, FL; Department of Psychology, University of South Florida, Tampa, FL. Electronic address: Risa.Richardson@va.gov.
authors.forename: Risa
authors.initials: R
authors.lastname: Nakase-Richardson
authors.forename: Johanna
authors.initials: J
authors.lastname: Tran
authors.forename: David
authors.initials: D
authors.lastname: Cifu
authors.forename: Scott D
authors.initials: SD
authors.lastname: Barnett
authors.forename: Lawrence J
authors.initials: LJ
authors.lastname: Horn
authors.forename: Brian D
authors.initials: BD
authors.lastname: Greenwald
authors.forename: Robert C
authors.initials: RC
authors.lastname: Brunner
authors.forename: John
authors.initials: J
authors.lastname: Whyte
authors.forename: Flora M
authors.initials: FM
authors.lastname: Hammond
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Yablon
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Giacino
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000150:complications / Q000534:rehabilitation*; D003244:Consciousness Disorders / Q000209:etiology / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States
keywords: CI; Consciousness disorders; DOC; DRS; Disability Rating Scale; ED; GCS; Glasgow Coma Scale; IRR; LSM; MCS; NIDRR; National Institute on Disability and Rehabilitation Research; Rehabilitation; TBI; TBI Model Systems; TBIMS; TFC; Traumatic brain injuries; VS; confidence interval; disorders of consciousness; emergency department; incidence rate ratio; least squares mean; minimally conscious state; time to follow commands; traumatic brain injury; vegetative state