Examining the accuracy of the AM-PAC “6-clicks” at predicting discharge disposition in traumatic brain injury

ABSTRACT

Objective

To assess the accuracy of the AM-PAC “6-Clicks” in predicting discharge dispositions among severely injured patients with an acute traumatic brain injury (TBI).

Methods

We performed a retrospective review of patients with a TBI who presented to our trauma center from 2016 through 2018 and received a “6-Clicks” assessment. Outcomes were hospital length of stay (LOS) and discharge disposition: home, inpatient rehabilitation facility (IRF), subacute location (SL), or death/hospice. Subgroup analyses evaluated patients with concomitant mobility-limiting injuries (CM-LI).

Results

There were 432 patients with a TBI; 42.6% (n = 184) had CM-LI. CM-LI patients had lower “6-Clicks” scores compared to patients with an isolated TBI (9 vs 14, p < .0001) and a longer hospital LOS (16.5 d vs 9 d, p < .0001). Increasing “6-Clicks” scores were associated with a home discharge (OR 1.21, 95% CI 1.15–1.28, p < .0001) while decreasing scores were predictive of an IRF or SL discharge or death/hospice. Increasing scores correlated with decreasing hospital LOS for the cohort (β − 8.93, 95% CI −10.24 – −7.62, p < .0001).

Conclusion

Among patients with an acute TBI, increasing “6 Clicks” scores were associated with a shorter hospital LOS and greater likelihood of home discharge. Decreasing mobility scores correlated with discharge to an IRF, SL, and death/hospice.

KEYWORDS:

• Functional status
• traumatic brain injury
• postacute care
• length of stay

Acknowledgments

None

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.