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Arch Phys Med Rehabil 96:e17-e18.
Toronto Rehabilitation Institute, Toronto, ON, Canada
Objective(s): To investigate demographic and acute care clinical determinants of admission to inpatient rehabilitation (IR) among hypoxicischemic brain injury (HIBi) patients who survive the initial acute care episode.
Design: Prospective cohort.
Setting: Ontario, Canada.
Participants: All patients aged 20 years and older with a HIBi in acute care, identified by specified International Classification of Diseases Version IO codes, and discharged to IR following acute care discharge between April 2002 and December 2010 (N=593).
Interventions: NI A.
Main Outcome Measure(s): Admission to IR.
Results: Twenty-eight percent of HIBi survivors were admitted to IR following discharge from acute care within one year, while 19.6% of survivors were transferred directly. Of patients admitted to IR, 40.6% had a HIBi-associated admitting diagnosis, though this proportion was increased for those admitted directly (55.2% ). A little over half received rehabilitation specific to non-traumatic acquired brain injury (56.7%), the appropriate designation for HIBL Younger age, male sex, lower comorbidity burden, length of stay of preceding acute care episode and markers of delayed acute care discharge were most predictive of admission to IR in multivariable regression models. Patients younger than 64 had an 80 percent higher incidence of admission to IR (RR (Relative Risk): 1.78; 95% CI: 1.35-2.35) with the effect strongest for those under 50. Women had an almost 2-fold (RR: 0.65; 95% CI: 0.49-0.85) lower incidence of admission to IR.
Conclusions: Older age, higher comorbidity burden, longer lengths of preceding acute care stay and delayed discharge from acute are significant barriers to IR admission for HIBi patients. That women are almost 2-fold less likely to receive rehabilitation treatment is alarming and requires further investigation in future sex-specific research.
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