Determinants of admission to inpatient rehabilitation among acute care survivors of hypoxic-ischemic brain injury: a prospective population-wide cohort study

Objectives — To investigate demographic and acute care clinical determinants of admission to inpatient rehabilitation (IR) among hypoxic-ischemic brain injury (HIBI) patients who survive the initial acute care episode.

Design — Population-wide prospective cohort study using Canadian Institutes for Health Information administrative health data from Ontario, Canada. All patients who survived their HIBI acute care episode during the study period remained eligible for the outcome, admission to inpatient rehabilitation, for one year post acute care discharge.

Setting — Ontario, Canada acute care.

Participants — We included all HIBI patients using International Classification of Diseases-Tenth Revision codes (ICD-10-CA) recorded at acute care admission who were 20 years or older (n=599) and discharged from acute care between 2002 and 2010 fiscal years, inclusive. Six were excluded from analyses due to missing data.

Interventions — Not Applicable.

Main Outcome Measure — Admission to inpatient rehabilitation

Results — Of HIBI survivors admitted to IR within one year of acute care discharge (n=169), the majority (56.2%) had an IR admitting diagnosis indicating “anoxic brain damage”. Younger age, male sex, lower comorbidity burden, longer length of stay of preceding acute care episode and shorter duration in special care were most predictive of admission to IR in multivariable regression models. Females had an almost 2-fold lower incidence of admission to IR (Risk Ratio (RR): 0.62; 95% CI: 0.46-0.84).

Conclusion — Older age, higher comorbidity burden, and shorter lengths of stay and delayed discharge from acute care are associated with lower incidence of IR admission for HIBI patients. That females are almost 2-fold less likely to receive rehabilitation requires further investigation.