FACTORS AFFECTING HOSPITAL LENGTH OF STAY AND CHARGES FOLLOWING TRAUMATIC BRAIN INJURY

Objective: To examine the effect of initial severity of traumatic brai n injury (TBI), level of functional independence at admission to rehab ilitation, medical complications, mechanism of injury, and payer sourc e on hospital length of stay (LOS) and charges. Design: Cohort analysi s. Setting: Inpatient rehabilitation. Patients: 525 subjects from the National Institute on Disability and Rehabilitation Research TBI Model Systems National Data Base with relatively mild to severe TBI, an ave rage Glasgow Coma Scale (GCS) score of 8.5 (SD=3.9), and average durat ion of impaired consciousness (DIC) of 15.1 days (SD=40.6). Interventi on: Inpatient rehabilitation. Main Outcome Measures: Hospital LOS, hos pital charges. Results: Persons with lower initial GCS scores generall y reached the rehabilitation setting later and stayed longer than pers ons with higher initial GCS scores. Within each GCS level, lower initi al Functional independence Measure (FIM) scores were associated with l onger acute care and rehabilitation LOS. For persons admitted to rehab ilitation with relatively high or medium FIM scores, greater severity of injury resulted in relatively modest increases in rehabilitation LO S. In contrast, low admission FIM scores were associated with much lon ger rehabilitation LOS for patients with severe injuries, compared wit h those with relatively mild injuries. Initial GCS score, DIC, admissi on FIM, and acute LOS accounted for 48% (adjusted R(2)) of the varianc e in rehabilitation LOS and 42% of the variance in rehabilitation hosp ital charges. Of the medical complications examined, only neurologic c omplications and intracranial operations added significantly to the mo del, explaining an additional 2% of the variance In rehabilitation LOS . The effect of payer source on LOS is complicated by age as well as b y severity and mechanism of injury. Conclusions: Age, severity of inju ry, and medical complications are powerful predictors of rehabilitatio n LOS and hospital charges. Other factors, such as functional independ ence at rehabilitation admission and length of acute hospitalization, explain additional variance. None of these factors in isolation is abl e to sufficiently predict rehabilitation LOS or charges. Multidimensio nal analysis of these factors is necessary to plan or administer the d elivery of brain injury services.