title: Readmission to the acute care unit and functional outcomes in patients with severe brain injury during rehabilitation.
abstract: BACKGROUND
  Medical and surgical complications are common after brain lesions and may require acute care unit readmission (ACUR) during the rehabilitation stay. This clinical phenomenon has not been explored in subjects with severe brain injury (sBI).
  
  
  OBJECTIVE
  Because sBI patients come from the intensive care unit (ICU), patients may be transferred to rehabilitation before complete clinical stabilization. We investigated ACUR and causes as well as whether those who required ACUR had different functional outcomes.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Dedicated rehabilitation setting.
  
  
  METHODS
  Adult subjects with sBI causing a disorder of consciousness graded 3-8 on the Glasgow Coma Scale admitted to a dedicated rehabilitative setting were prospectively enrolled from January 2014 to December 2015.
  
  
  METHODS
  Functional outcome was investigated using the Rancho Los Amigos Levels of Cognitive Functioning (LCF), Disability Rating Scale (DRS), Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), in subjects with and without ACUR, at admission and discharge. Mortality and length of stay (LOS) were recorded.
  
  
  RESULTS
  One hundred-thirty (53 F, 77 M; mean age: 55.7±17.8) subjects were admitted to the rehabilitation setting, and 97 were enrolled (43 F, 54 M; mean age: 54.7±18.2). Thirty-six ACUR were detected that involved 29 (29.8%) patients. There were 20 and 16 referrals to acute medical and surgical care, respectively. Significant functional outcomes in all assessment measures were observed after rehabilitation, but subjects without ACUR showed significant improvement in all measurements: LCF (P=0.001), DRS (P<0.001), GOS (P=0.003), and mRS (P<0.001), compared to those who required ACUR. At baseline, patients with ACUR were more disabled than those without ACUR, and they had significant lower LCF scores: 2.60 (95% CI: 2.15-3.14) and 3.47 (95% CI: 3.07-3.91) (P=0.013), respectively. Significant longer LOS was observed in subjects with ACUR as compared to those without ACUR: 120 (q1-q3:93-165) vs. 63 (q1-q3: 38-93) days (P<0.001), respectively. The intra-hospital mortality rate was higher in patients who required ACUR (8.1 events per 100 person-months) as compared to those who did not require ACUR (2.8 events per 100 person-months).
  
  
  CONCLUSIONS
  Readmission to acute care was common in subjects with sBI during rehabilitation. Subjects who required ACUR had poorer functional outcomes, higher risk of mortality and longer LOS than subjects without ACUR.
  
  
  CONCLUSIONS
  Careful control of these subjects and more strict collaboration and communication among physicians on the rehabilitative team are required to plan proper care pathways.
authors: Unit of Physical Medicine and Rehabilitation, Section of Neurorehabilitation, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy - d.intiso@operapadrepio.it.
authors: Domenico
authors: D
authors: Intiso
authors: Unit of Biostatistics, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy.
authors: Andrea
authors: A
authors: Fontana
authors: Unit of Physical Medicine and Rehabilitation, Section of Neurorehabilitation, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy.
authors: Giuseppe
authors: G
authors: Maruzzi
authors: Unit of Physical Medicine and Rehabilitation, Section of Neurorehabilitation, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy.
authors: Maurizio
authors: M
authors: Tolfa
authors: Unit of Biostatistics, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy.
authors: Massimiliano
authors: M
authors: Copetti
authors: Unit of Physical Medicine and Rehabilitation, Section of Neurorehabilitation, IRCCS &quot;Casa Sollievo della Sofferenza&quot;, San Giovanni Rotondo, Foggia, Italy.
authors: Filomena
authors: F
authors: DI Rienzo
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends*; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D017933:Peripheral Nervous System / Q000502:physiology*; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers