title: Which factors influence the need for inpatient rehabilitation after severe trauma?
abstract: BACKGROUND
  Despite the importance of rehabilitation in the treatment of patients with severe trauma or even of severely injured patients, the cooperation between acute and rehabilitation hospitals is often inadequate. The present study aims to identify factors that make it probable that a severely injured patient requires inpatient rehabilitation following the acute treatment.
  
  
  METHODS
  A retrospective analysis of 75.357 cases from the TraumaRegister DGU®(TR-DGU) was performed. All cases from 2002 until 2013 with an ISS≥9, who were taken to the ICU were included. Regarding the discharge destination the subgroups "at home" and "rehabilitation hospital" were analyzed in detail. Finally, we performed a multivariate regression analysis based on the parameters previously collected.
  
  
  RESULTS
  24.208 patients (32.1%) were transferred to a rehabilitation clinic. In the multivariate regression analysis the most relevant independent parameters for discharge in a rehabilitation hospital were age (18-54: OR 1.65; 55-74: OR 2.86 and 75 and older: OR 5.07, all p≤0.001), AIS pelvis≥2 (OD 1.94), AIS legs (OR 2.02), AIS spine (AIS 4: OR 5.78 and AIS 5-6: OR 6.36) and the AIS head (AIS 3: OR 1.88; AIS 4: OR 3.11 and AIS 5-6: OR 7.55) (all p≤0.001). The length of stay in the ICU (3-7 days: OR 1.88; 8-28 Days: OR 5.42 and 29 and more days: OR 14.7, all p≤0.001) was also a relevant parameter. The overall ISS presented no relevant influence with an OR of 1.02 (p=0.03).
  
  
  CONCLUSIONS
  Knowing independent factors for a required inpatient rehabilitation helps the treating physicians to identify the patients at an early stage in acute hospitals. So the transfer to a rehabilitation clinic can be organized faster and more selective in future.
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: debusfl@med.uni-marburg.de.
authors: Florian
authors: F
authors: Debus
authors: Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany. Electronic address: rolf.lefering@uni-wh.de.
authors: Rolf
authors: R
authors: Lefering
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: langn@med.uni-marburg.de.
authors: Nils
authors: N
authors: Lang
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: oberkirch@med.uni-marburg.de.
authors: Ludwig
authors: L
authors: Oberkircher
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: bockmann@med.uni-marburg.de.
authors: Benjamin
authors: B
authors: Bockmann
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: ruchholtz@med.uni-marburg.de.
authors: Steffen
authors: S
authors: Ruchholtz
authors: Center for Orthopaedic and Trauma Surgery, University Hospital Gießen and Marburg, Location Marburg, Baldingerstr., 35043 Marburg, Germany. Electronic address: kuehnec@med.uni-marburg.de.
authors: Christian Alexander
authors: CA
authors: Kühne
authors: Committee on Emergency Medicine, Intensive Care and Trauma Management of the German Trauma Society (Sektion NIS), Germany.
authors: The TraumaRegister Dgu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007297:Inpatients; D033183:Interdisciplinary Communication; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000534:rehabilitation*; D020380:Needs Assessment; D018579:Patient Selection; D010360:Patient Transfer / Q000458:organization & administration* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012042:Registries; D012047:Rehabilitation Centers / Q000458:organization & administration; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers / Q000458:organization & administration; D055815:Young Adult
keywords: Cooperation; Rehabilitation; Severe trauma; TraumaRegister DGU