Characteristics of individuals with moderate-to-severe traumatic brain injury and predictors of interhospital transfer and specialized rehabilitation: a retrospective cohort study

Abstract Purpose Traumatic brain injury (TBI) is a disabling neurological condition that can cause substantial cognitive, behavioural, and physical health problems for the individual. Currently, it is a leading cause of death for Canadians. Rehabilitation (particularly specialized rehabilitation) has been shown to promote recovery in those with moderate-to-severe TBI, but not all eligible candidates receive it. Interhospital transfer (IHT), defined as a patient’s transfer from one acute care hospital to another within the same episode of acute care as the index TBI hospitalization, may be a significant factor in determining whether someone receives specialized rehabilitation. Thus, we aim to (1) investigate demographic and clinical characteristics of individuals with moderate-to-severe TBI discharged to rehabilitation within 1-year post-injury over a 7-year period, and (2) identify predictors of IHT and discharge to specialized rehabilitation for these individuals. Methods Patient characteristics were examined by linking their unique health insurance number through databases. Predictors of specialized rehabilitation and IHT prior to discharge to rehabilitation were determined using logistic regression models. Results Of 25,095 individuals with moderate-to-severe TBI in Ontario, 4,748 were admitted to rehabilitation within 365 days of injury between 2010/2011 and 2017/2018. Most individuals who were admitted to rehabilitation were 65 years old or older (59.2%). Majority were male (65.6%). The most common cause of injury was related to a fall (61.7%). Mean wait time to rehabilitation was 37.3 (± 52.5) days, and 72.1% were discharged directly to rehabilitation following acute discharge. Following rehabilitation discharge, 7.3% were immediately rehospitalized. Younger age, male sex, and greater rurality (i.e., residence in a medium urban region or small town) were some significant predictors of receiving specialized rehabilitation, while patients who experienced IHT were less likely to receive specialized care. Older age (i.e., 46–64, 65–80, 81 + years), male sex, and greater rurality were some significant predictors of IHT. Conclusions This study identified key healthcare utilization characteristics of individuals with moderate-to-severe TBI and found several significant predictors of IHT and discharge to specialized rehabilitation for this population. We also highlight potential future research areas relating to these trends. This knowledge will be useful for policy planners and administrators who wish to improve patient access to care, appropriateness of care, and outcomes following moderate-to-severe TBI.