Risk factors for acute care transfer among traumatic brain injury patients

Objective: Acute inpatient traumatic brain injury (TBI) rehabilitation has seen a jump in complexity of medical patient care over the past several years, often necessitating transfer back to an acute care facility. The purpose of this study was to determine the association between selected clinical variables and transfer from inpatient rehabilitation to an acute care facility. Design: A retrospective review of cases from 1992 to 1994. Setting: A TBI unit in a freestanding rehabilitation hospital. Patients: Twenty-two patients were identified as having received acute care transfer. This group was compared with 78 patients, admitted in the same interval, who did not require acute care transfer. The variables evaluated included recent surgery, pneumonia, fracture, intracranial blood, tracheostomy use, percutaneous feeding tube use, deep venous thrombosis, focal neurological examination, following simple commands, serum sodium level of <135mmol/L, serum white blood cell count of >11,000 cells/mu L, and serum hemoglobin level of <10.0g/dL. Analysis: Chi-square analysis was performed on the association between acute care transfer and the noted variables. Results: History of pneumonia (p<.03) and history of recent surgery (p<.02) were both associated with acute care transfer, and serum hemoglobin of <10.0g/dL had a trend towards association (p<.10). Conclusion: Physiatrists caring for the TBI patient may warrant more acute observation of individuals with these parameters to prevent the problems necessitating acute care transfer. (C) 1997 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.