Access to inpatient rehabilitation after violence-related traumatic brain injury

Esselman PC, Dikmen SS, Bell K, Temkin NR. Access to inpatient rehabilitation after violence-related traumatic brain injury. Arch Phys Med Rehabil 2004;85:1445-9. Objectives To examine injury characteristics, demographics, and discharge disposition after traumatic brain injury of violent or nonviolent cause. Design Cohort study. Setting Level I trauma center. Participants Patients (N=1807) admitted with a Head Abbreviated Injury Score (AIS) of 2 or more over a 2-year period. Interventions Not applicable. Main outcome measures Injury cause was classified as violent or nonviolent. Discharge disposition was classified as home, inpatient rehabilitation, skilled nursing facility (SNF), and other. Results The violence group was more likely to be male, to include individuals from diverse racial groups, to have an alcohol level above the legal limit, to have a more severe Head AIS, and to have Medicaid funding and equal access to inpatient rehabilitation compared with the nonviolence group. The violence group, though, was more likely to be discharged to home than to inpatient rehabilitation and more likely to be discharged to inpatient rehabilitation than to an SNF. The nonviolence group had a longer acute care length of stay and a higher rate of injuries to other body systems. Conclusions People with violence-related injuries often present unique rehabilitation challenges. After accounting for injury severity and demographics, there was no evidence of bias against the violently injured in gaining access to inpatient rehabilitation services.