Presence of a dedicated trauma center physiatrist improves functional outcomes following traumatic brain injury.
BACKGROUND
Maximizing long-term recovery following traumatic brain injury (TBI) is an important end point. We hypothesized that the addition of a dedicated physiatrist specializing in brain injury medicine to the trauma team would lead to improved functional outcomes.


METHODS
Data from the Northern NJ TBI Model Systems were queried for all patients admitted to rehabilitation from four regional trauma centers, one with a full-time TBI physiatrist (PHYS) and three without (NO-PHYS). Patient demographics, mechanism of injury, Glasgow Coma Scale (GCS) score, length of posttraumatic amnesia, length of stay, and Functional Independence Measure (FIM) were abstracted. TBI severity was determined by GCS score and length of posttraumatic amnesia. FIM motor and cognitive scores at rehabilitation admission and discharge were the primary outcome measure. TBI medications (stimulants, sleep, and neurodepressants) administered in acute care were reviewed to evaluate prescription patterns.


RESULTS
A total of 148 patients treated at four trauma centers and discharged to a single acute inpatient rehabilitation center between 2005 to 2013 were divided into two groups, PHYS with 44 patients and NO-PHYS with 104 patients. Compared with those in the NO-PHYS group, patients from the PHYS group had significant improvement in FIM motor and cognitive scores (p < 0.05). Prescription patterns differed. Patients from the PHYS group received significantly more neurostimulants (p < 0.001) and sleep medications (p = 0.02) compared with the NO-PHYS group. Analysis of covariance was conducted to examine FIM (motor and cognitive) changes from rehabilitation admission to discharge based on medications initiated in acute care. Those who received neither a neurostimulant nor a sleep medication had significantly lower FIM motor scores compared with those who received at least one of these medications (p = 0.047) and compared with those who received both types of medication (p = 0.17). No significant differences were found in FIM cognitive scores.


CONCLUSIONS
The addition of a dedicated physiatrist providing early specialized care to patients who sustained a moderate or severe TBI was associated with improved functional outcomes upon discharge from rehabilitation. The presence of a dedicated trauma center physiatrist, trained in TBI rehabilitation, was also associated with a change in neuroprotective medication management in the acute care setting.


METHODS
Therapeutic study, level IV.
From the Departments of Physical Medicine and Rehabilitation (C.G., L.D.), and Surgery (P.P.Y., D.H.L.), Rutgers-New Jersey Medical School, Newark; and Department of Physical Medicine and Rehabilitation (C.G.), Kessler Institute for Rehabilitation (N.J., A.L., I.W., N.C., G.F.), West Orange, New Jersey.
Christine
C
Greiss
Peter P
PP
Yonclas
Neil
N
Jasey
Anthony
A
Lequerica
Irene
I
Ward
Nancy
N
Chiaravalloti
Gabriel
G
Felix
Laurie
L
Dabaghian
David H
DH
Livingston
D001930:Brain Injuries / Q000534:rehabilitation*; D004185:Disability Evaluation; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009515:New Jersey; D010810:Physical and Rehabilitation Medicine; D058996:Quality Improvement; D020127:Recovery of Function; D012047:Rehabilitation Centers; D014193:Trauma Centers; D000078329:Workforce