Epidemiology and clinical outcomes in a multicentre regional cohort of patients with severe acquired brain injury

Abstract

Purpose: To evaluate epidemiological and clinical data on patients with severe acquired brain injury (sABI) admitted to rehabilitation units in the first 6 years since the inception of a regional register (2005–2010) in the Emilia-Romagna region (Italy).

Method: Retrospective multicentre study of a regional cohort using data from an online regional register (Gravi Cerebrolesioni Emilia-Romagna – GRACER). The study included 318 patients who suffered sABI (defined by Glasgow Coma Scale score ≤8 recorded in the initial 24 h following injury), who were admitted to and subsequently discharged from rehabilitation units. Physical and cognitive functions were evaluated at admission and discharge. Other data recorded included aetiology, presence of secondary conditions and need for specific medical support.

Results: Three-quarters of patients displayed improvements in physical and/or cognitive function at discharge from rehabilitation units, with 71.4% of patients returning home. Better outcomes at discharge were associated in particular with younger age, traumatic brain injury (versus non-traumatic), or absence of tracheostomy at admission.

Conclusion: The GRACER register is a useful tool for the assessment of epidemiological and clinical information on sABI patients. In light of the positive impact on patient outcomes, rehabilitation in specialised units is highly encouraged and should occur as soon as possible.

Implications for Rehabilitation

• There is a need for more epidemiological and clinical data associated with severe acquired brain injury, particular regarding those of non-traumatic origin.

• In a retrospective multicentre study of a regional cohort using data from an online regional register in Italy (GRACER), more than three-quarters of patients displayed improvements in physical and/or cognitive function at discharge from the rehabilitation units. Better outcomes at discharge were associated in particular with younger age, traumatic brain injury (versus non-traumatic) or absence of tracheostomy at admission.

• Admission to a specialised rehabilitation unit is highly encouraged for patients with severe acquired brain injury, and should occur as soon as possible.

• Policy-makers and service planners should continue to develop strategies and allocate adequate resources for rehabilitation services due to their positive impact on patient outcomes. In particular, patients with conditions associated with increased likelihood of poor outcomes may require special attention during rehabilitation to improve outcomes at discharge.

Keywords:

• Age
• assessment
• brain injury
• outcomes
• sex

Declaration of interest

The authors report no declarations of interest.