J. P. Herrera-Escobar1, R. Manzano-Nunez1, S. S. Al Rafai1, A. Toppo1, K. Han2, N. Bhulani1, G. Kasotakis3, G. Velmahos2, A. Salim4, A. H. Haider1,4, D. Nehra4 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Massachusetts General Hospital,Division Of Trauma, Emergency Surgery & Surgical Critical Care,Boston, MA, USA 3Boston University,Boston, MA, USA 4Brigham And Women’s Hospital,Division Of Trauma, Burn, And Surgical Critical Care,Boston, MA, USA
Introduction: Most of the 96% of patients who survive traumatic injuries require ongoing rehabilitation after discharge. However, the long-term impact of post-discharge rehabilitation care remains poorly understood. In this study, we sought to compare the likelihood of persistent pain needing medication 6 to 12 months after traumatic injury between patients discharged to an inpatient rehabilitation facility (IRF) and a skilled nursing facility (SNF).
Methods: Moderate to severe [Injury Severity Score (ISS) ≥ 9] trauma patients admitted to 1 of 3 Level-I trauma centers were interviewed between 6 and 12 months after injury from 2015 to 2018. During the interview, the presence of daily pain and need of pain medications were evaluated using the Trauma Quality of Life (T-QoL) questionnaire. This information was linked to the index hospitalization through the trauma registry. Inverse probability of treatment weighting (IPTW)–adjusted logistic regression analysis was performed to compare the likelihood of persistent pain requiring medication among patients who were discharged to IRF vs SNF. Factors used for the propensity score calculation included age, gender, insurance, comorbidities, injury type, polytrauma, ISS, head injury, extremities injury, intensive care unit admission, ventilator use, complications, length of stay, and hospital.
Results: A total of 519 patients were included in the analysis: 389 discharged to IRFs and 130 to SNFs respectively. Unweighted and weighted baseline characteristics are described in Table 1. In unweighted analysis, rates of pain needing medication were 29.1% for IRF vs 40.8% for SNF (P: .013). After IPTW adjustment, propensity score distribution between IRF vs SNF achieved adequate balance and standardized differences were less than 10% (Table 1), which indicated that patients of both groups were subsequently comparable. IPTW-adjusted rates of pain needing medication were 28.9% for IRF vs 47.5% for SNF. In the IPTW-adjusted logistic regression analysis, IRF was associated with a significant reduction in the likelihood of chronic pain after injury (OR 0.45; 95% CI, 0.23-0.90; P = .023).
Conclusion: IRFs may be associated with a reduction in the likelihood of chronic pain after trauma. The reasons for this difference are unknown, but it is likely to be multifactorial and perhaps we should consider IRF over SNF for patients at high risk for chronic pain after traumatic injury.
