Characteristics and Functional Impact of Unplanned Acute Care Unit Readmissions during Inpatient Traumatic Brain Injury Rehabilitation: A Retrospective Cohort Study

Background: This study investigated the incidence, characteristics and functional outcomes associated with unplanned Acute Care Unit Readmissions (ACUR) during inpatient traumatic brain injury (TBI) rehabilitation in an Asian cohort. Methods: A retrospective review of electronic medical records from a single rehabilitation unit was conducted from 1 January 2012 to 31 December 2014. Inclusion criteria were first TBI, aged >18 years, admitted <6 months of TBI. ACUR were characterized into neurological, medical or neurosurgical subtypes. The main outcome measure was discharge and Functional Independence Measure (FIM<(TM)>). Secondary outcomes included rehabilitation length of stay (RLOS). Results: Of 121 eligible TBI records, the incidence of ACUR was 14% (n = 17), comprising neurologic (76.5%) and medical (23.5%) subtypes occurring at median of 13 days (IQR 6, 28.5) after rehabilitation admission. Patients without ACUR had a significantly higher admission mean (SD) FIM score compared to those with ACUR (FIM ACUR-negative 63.4 (21.1) vs. FIM ACUR-positive 50.53(25.4), p = 0.026). Significantly lower discharge FIM was noted in those with ACUR compared to those without. (FIM ACUR-positive 65.8(31.4) vs. FIM ACUR-negative 85.4 (21.1), p = 0.023) Furthermore, a significant near-doubling of RLOS was noted in ACUR patients compared to non-ACUR counterparts (ACUR-positive median 55 days (IQR 34.50, 87.50) vs. ACUR-negative median 28 days (IQR 16.25, 40.00), p = 0.002). Conclusions: This study highlights the significant negative functional impact and lengthening of rehabilitation duration of ACUR on inpatient rehabilitation outcome for TBI.