C. W. Lancaster1, P. Ayoung-Chee2 1Emory University School Of Medicine,Atlanta, GA, USA 2New York University School Of Medicine,Department Of Surgery, Division Of Trauma, Emergency Surgery And Surgical Critical Care,New York, NY, USA
Introduction:
Traumatic injury can result in substantial loss of physical function. Of the 18.1% of trauma patients discharged to post-acute care, 19.5% are discharged to an inpatient rehabilitation facility (IRF). Admission to IRF is based on expected functional improvement, but there is little data that documents benefit in injured patients. The purpose of this study was to quantify functional improvements experienced by trauma patients after discharge from IRF and identify predictors of functional improvement.
Methods:
Data were retrospectively collected on patients ≥18 yrs old admitted after injury to a Level 1 trauma center from January, 2012, to March, 2013, and discharged to IRF. Data included demographics, injury characteristics, hospital course (e.g. procedures, length of stay (LOS)), and IRF course (e.g. LOS). The functional independence measure (FIM) was used to measure change in physical and cognitive function from IRF admission to discharge. The FIM score is the sum of scores (range 1 (total assistance) to 7 (total independence)) from 18 domains (13 motor, 5 cognitive).
Results:
There were 136 patients with a mean (SD) age of 56 yrs (21.3). Most (99.3%) were living at home, alone or with support, at time of injury. Mean Charlson Comorbidity Score (CCS) was 0.17 (0.46). Fall was the leading mechanism of injury (44.9%). Median (range) injury severity score (ISS) was 9 (0-45). Median hospital LOS was 8 days (2-89). Mean IRF LOS was 14.3 days (8.07). Due to extenuating circumstances, 11 were transferred to other IRFs and not included. Of the remainder, FIM scores were available for 124. On IRF admission, 43.6% required moderate assistance or greater. From IRF admission to discharge, the mean intra-individual change in FIM score was 28.3 (18.0); 84.7% improved ≥1 levels of independence. On discharge from IRF, 53.2% were at a modified independent level of independence or better; 49.6% were discharged home (with family or agency support); 20.8% were discharged to skilled nursing facility; 21.6% were readmitted to acute care; 8.0% were discharged home independently. Using multivariable analysis, for every 1 yr increase in age, improvement in FIM scores decreased by 0.15 (p=0.05) when adjusted for CCS, primary injury (PI), ISS, intensive care unit (ICU) stay, and IRF LOS. For chest PI, improvement in FIM scores decreased by 17.2 (p=0.04) when adjusted for age, CCS, ISS, ICU stay, and IRF LOS. For every 1 day increase in IRF LOS, improvement in FIM scores increased by 0.65 (p=0.002) when adjusted for age, CCS, PI, ISS, and ICU stay.
Conclusion:
Trauma patients experienced improved functionality after admission to IRF: 80.7% of patients experienced an increase in level of independence. However, despite this improvement, 42.4% of patients were unable to be discharged home. While significant predictors of functional improvement are non-modifiable, they are known at time of acute hospital admission and can help with early resource planning.