Abstract:
Objective: To investigate incidence and etiology of rehospitalizations at one and five years post traumatic brain injury.

Design: Prospective study of etiology and incidence of rehospitalizations at years 1 and 5 years postinjury. Analysis of variance and chi-square were used to identify factors relating to rehospitalization; factors included length of stay, admission and discharge functional status, payor source, medical complications, injury severity, and demographics.

Setting: Seventeen medical centers in the federally sponsored Traumatic Brain Injury Model Systems. In each setting, the continuum of care includes emergency medical services, intensive and acute medical care, inpatient rehabilitation, and a spectrum of community rehabilitation services.

Participants: 895 rehabilitation patients admitted to acute care within 24 hours of traumatic brain injury between 1989 and 1999 were examined at one year follow-up. 442 rehabilitation patients admitted to acute care within 24 hours of traumatic brain injury between 1989 and 1996 were examined at either four or five year follow-up. In cases where the five year follow-up was unavailable, data from the four year follow-up was used.

Main Outcome Measures: Incidence and etiology of rehospitalization at one and five years postinjury.

Results: The incidence of rehospitalization ranged from 22.9% at one year postinjury to 17.0% at five years postinjury. At one year postinjury, a third of the rehospitalizations were for elective reasons. The most common reason for rehospitalizations was for orthopedic or r econstructive surgery, followed by general health maintenance and seizures. At five years postinjury, the incidence of readmissions for seizures and psychiatric difficulties as well as general health maintenance increased substantially. A chi-square analysis was performed to compare one year to five year data with regard to incidence and etiology of rehospitalization. T-tests and chi-square analyses were performed on the five year follow-up data to compare those rehospitalized for unplanned reasons to those not rehospitalized. No statistically significant associations were noted between incidence and etiology of rehospitalization and demographics; injury severity; payor source for rehabilitation; concurrent injuries; acute care and rehabilitation length of stays; and discharge FIM (p > .05). However, patients not rehospitalized were significantly more likely to be living in a private residence than patients who were rehospitalized at long-term follow-up (p = .004).

Conclusions: There remains a relatively high rate of rehospitalization in the long term following traumatic brain injury. The costs of rehospitalization should be considered when evaluating the long-term consequences of injury.