Journal of Head Trauma Rehabilitation最新文献

{"title":"The Accuracy of the PHQ-2 Alone and Combined With the PHQ-9 to Identify Major Depression in Traumatic Brain Injury.","authors":"Charles H Bombardier, Erin G Mistretta, Rebecca Altschuler, Jason Barber, Jesse R Fann","doi":"10.1097/HTR.0000000000001054","DOIUrl":"10.1097/HTR.0000000000001054","url":null,"abstract":"<p><strong>Objective: </strong>To assess the reliability, construct validity, and screening accuracy of the Patient Health Questionnaire-2 (PHQ-2) and the combined PHQ-2/PHQ-9 to detect major depressive disorder (MDD) in persons with traumatic brain injury (TBI).</p><p><strong>Setting: </strong>Level 1 trauma center.</p><p><strong>Participants: </strong>Participants were 135 adults within 1 year of sustaining complicated mild, moderate, or severe TBI, initially recruited for a depression treatment trial.</p><p><strong>Design: </strong>Screening validity study relative to structured diagnostic assessment.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main measures: </strong>PHQ-2 and PHQ-9 depression scales, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.</p><p><strong>Results: </strong>The optimal cutoff for the PHQ-2 alone is a score of 2 or more which results in a sensitivity of .86 and a specificity of .83. When the PHQ-2 and PHQ-9 are combined in a 2-step process, the optimal cutoffs are 1 or more on the PHQ-2 and a total of 5 or more of the 9 PHQ-9 symptoms endorsed at least several days in the past 2 weeks. This resulted in a sensitivity of .93 and a specificity of .89 and only 53.6% of patients needed to be administered the entire PHQ-9.</p><p><strong>Conclusion: </strong>The 2-step PHQ-2/PHQ-9 screening process described here represents an efficient, reliable, and valid means of detecting MDD in people with TBI. Results suggest that the generic PHQ-2/PHQ-9 depression screening parameters adopted within large U.S. federal entities may disadvantage people with TBI.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E340-E348"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impacts of Traumatic Brain Injury and Severe Limb Injury on Death by Suicide: Concurrent Investigations Using Path Analysis.","authors":"Samuel Y Chung, Jordan A Levine, Emily A Schmied, John C Shero, Christopher L Dearth, Jennifer N Belding","doi":"10.1097/HTR.0000000000001053","DOIUrl":"10.1097/HTR.0000000000001053","url":null,"abstract":"<p><strong>Objective: </strong>Utilize path analysis to examine the concurrent associations of traumatic brain injury (TBI) and severe limb injury (SLI) with death by suicide mediated by psychological health (PH) conditions and substance use disorders (SUDs).</p><p><strong>Setting: </strong>Archival career and medical data were obtained from the Career History Archival Medical and Personnel System, the Expeditionary Medical Encounter Database, and the Defense Suicide Prevention Office Suicide Data Repository.</p><p><strong>Participants: </strong>Service members of the air force, army, marines corps, and navy who served more than 30 consecutive days between September 11, 2001, and September 30, 2016.</p><p><strong>Design: </strong>This retrospective cohort study utilized path analysis to examine associations among TBI, SLI, PH conditions, SUD, and death by suicide. Stratification by TBI was tested.</p><p><strong>Main measures: </strong>Concurrent associations of 2 focal predictors, TBI and SLI, with death by suicide were investigated, mediated by PH conditions (ie, posttraumatic stress disorder, depression, or anxiety disorder), and SUDs (ie, alcohol use disorder or other drug use disorder), adjusting for age, sex, race/ethnicity, service branch, and officer status.</p><p><strong>Results: </strong>In preliminary analyses, TBI, SLI, PH conditions, and SUD were all independently associated with death by suicide. In the first path model, neither of the direct effect of SLI or TBI on death by suicide were significant. TBI shared a stronger association with PH conditions and SUD than SLI did; the association between SLI and SUD was negative. When stratified by TBI status, the association between SUD and death by suicide was stronger among those without (vs with) TBI.</p><p><strong>Conclusions: </strong>Findings suggest complex and nuanced associations between TBI, SLI, PH conditions, SUD, and death by suicide, and underscore the importance of integrated and holistic treatment of injured military service members.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E420-E429"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Range of Motion and Pericranial Muscle Tenderness in Patients With Persistent Post-Concussion Symptoms: A Cross-Sectional Study.","authors":"Laura Westh Stenbro, Line Amalie Hellemose, Simple Futarmal Kothari, Helge Kasch, Jørgen Feldbæk Nielsen, Peter Preben Eggertsen","doi":"10.1097/HTR.0000000000001040","DOIUrl":"10.1097/HTR.0000000000001040","url":null,"abstract":"<p><strong>Objectives: </strong>To examine the active cervical range of motion (aCROM) in 15- to 30-year-old patients with high levels of persistent post-concussion symptoms (PCS) 2-6 months after a mild traumatic brain injury (mTBI) compared with healthy individuals. Additionally, we examined the association between aCROM, the severity of PCS (measured by the Rivermead Post-Concussion Symptom Questionnaire [RPQ]), and the pericranial tenderness score (pTTS).</p><p><strong>Setting: </strong>A research outpatient clinic at a rehabilitation hospital in the Central Denmark Region. Patients were recruited by referral from general practitioners or emergency departments.</p><p><strong>Participants: </strong>Young individuals (aged 15-30 years) with high levels of PCS (n = 108) within 2-6 months after a direct head trauma. Reference data of aCROM was obtained from a published study conducted on healthy individuals (n = 100) (aged 20-29 years).</p><p><strong>Design: </strong>Cross-sectional study using baseline data from a randomized controlled trial examining the effect of a non-pharmacological intervention for PCS.</p><p><strong>Main outcome measures: </strong>aCROM measured using a CROM 3 device, pTTS, and RPQ-score.</p><p><strong>Results: </strong>Patients with PCS had a 5% lower mean total aCROM compared with a published reference mean on healthy individuals (mean group difference [95% confidence interval] = -19°[-31; -7.0], P = .002). The reduction in aCROM was primarily driven by a subset of individuals (n = 12). A significant negative correlation was found between total pTTS and total aCROM ( ρ  = -.43, P < .001). There was no significant correlation between the RPQ score and the total aCROM (r = -0.12, P = .214).</p><p><strong>Conclusion: </strong>The findings indicate that concomitant cervical impairment may exist in a subset of patients with PCS. A clinical implication could be to include systematic neck examination in patients with mTBI to ensure accurate diagnosis. However, further research is necessary before implementing this information into regular clinical practice.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E391-E400"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Resumption of Physical Activity and Cognitive Outcomes at 4 Weeks Following Pediatric Concussion.","authors":"Veronik Sicard, Roger Zemek, Vid Bijelic, Nick Barrowman, Keith Owen Yeates, Miriam H Beauchamp, Brian L Brooks, Peter Anderson, Michelle Keightley, Naddley Desire, Andrée-Anne Ledoux","doi":"10.1097/HTR.0000000000001050","DOIUrl":"10.1097/HTR.0000000000001050","url":null,"abstract":"<p><strong>Background: </strong>Early physical activity (PA) after concussion may aid in symptom recovery, though its impact on other recovery domains, such as cognitive functioning, remains less explored.</p><p><strong>Objectives: </strong>(1) Examine the association between early PA (within 7 days post-injury) and cognitive inefficiency and impairment 4 weeks after pediatric concussion; (2) investigate the association between early PA and cognitive outcomes (memory and executive functioning, information processing speed, attention, visual-motor processing, and vocabulary) 4-week post-concussion.</p><p><strong>Setting: </strong>Emergency departments (EDs) of four Canadian pediatric hospitals within the Pediatric Emergency Research Canada (PERC) Network.</p><p><strong>Participants: </strong>Children aged 8-18 years presenting to the ED within 48 hours of a head injury and diagnosed with a concussion.</p><p><strong>Design: </strong>Planned secondary analysis of data from a prospective multicenter cohort study.</p><p><strong>Main measures: </strong>Participants' PA level was assessed at 1-week post-concussion through a self-report questionnaire in which they had to indicate their current level of recovery in terms of return to physical activities and sports. Early PA participation was defined as any level of PA other than \"no activity\" at the 1-week follow-up. Participants underwent comprehensive neuropsychological testing at 4-week post-concussion. Primary outcome measures included cognitive inefficiency and impairment (≥2 outcomes with z < -1.0 SD or <-1.5 SD below the normative mean, respectively). Secondary and tertiary outcome measures include t-scores and scaled scores from the 10 neuropsychological tasks, transformed to z-scores.</p><p><strong>Results: </strong>Early PA was not significantly associated with the likelihood of cognitive inefficiency or impairment ( P s ≥ .38). The early PA*sex interaction was related to verbal cognitive flexibility ( P = .02), with females engaging in early PA having better scores. Moreover, the early PA*age interaction was associated with attention ( P = .03), with younger children engaged in early PA performing worse.</p><p><strong>Conclusions: </strong>Early PA has no overall association with cognitive inefficiency or impairment but may be differentially associated with certain cognitive outcomes by age and sex.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E380-E390"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Implementation of an Occupational Therapy-Led Concussion Clinic Model Into Usual Practice: A Mixed Methods Study.","authors":"Adrianne Natoli, Ethan Hunt, Emma Hays, Eloise Thompson, Samantha Ioannidis, David J Read, Toni D Withiel, Celia Marston","doi":"10.1097/HTR.0000000000001025","DOIUrl":"10.1097/HTR.0000000000001025","url":null,"abstract":"<p><strong>Objectives: </strong>(1) To evaluate the implementation of Australia's first occupational therapy-led concussion clinic model into usual practice by examining acceptability and fidelity among clinicians and service users, and (2) to explore the feasibility of embedding outcome measures into the service to facilitate longer-term clinic evaluation.</p><p><strong>Setting and participants: </strong>A large tertiary trauma hospital service in Melbourne, Australia. Participants were patients referred to the concussion clinic and occupational therapists working in the service.</p><p><strong>Design: </strong>Prospective, single-site, mixed methods design.</p><p><strong>Main measures: </strong>Acceptability outcomes were evaluated using clinician interviews and the Client Satisfaction Questionnaire-8. Clinic fidelity was assessed by service usage data. Long-term patient outcomes assessed concussion (Rivermead Post-Concussive Questionnaire), mood symptoms (Patient Health Questionnaire-9), and participation in activities of daily living (Community Integration Questionnaire-Revised).</p><p><strong>Results: </strong>Over 18 months, 73% ( n  = 177) of patients were referred to the clinic, and 75% attended. Adherence to protocol was achieved; however, the completion rate of post-treatment measures was low. Almost half of the patients required specialist referrals beyond the clinic model for persistent symptoms. The interviewed occupational therapists ( n  = 6) viewed the clinic as a \"safety net for patients,\" believed they were \"learning as we go,\" recognized that the \"clinic had potential to grow,\" but admitted, \"we could be doing more.\" High attendance rates and patient satisfaction further supported clinic acceptance at an end-user level.</p><p><strong>Conclusion: </strong>An occupational therapy-led concussion clinic is accepted by patients and clinicians to capture the immediate needs of people with concussions after discharge. However, coordinated pathways to multidisciplinary care are needed to address the long-term needs of people with persistent concussion symptoms and problems returning to daily activities.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E401-E409"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts of the 5 th Annual Meeting of the Canadian Concussion Network/Réseau Canadien des Commotions (CCN-RCC).","authors":"","doi":"10.1097/HTR.0000000000001069","DOIUrl":"10.1097/HTR.0000000000001069","url":null,"abstract":"<p><p>The following abstracts were presented at the 5 th Annual Meeting of the Canadian Concussion Network/Réseau Canadien des Commotions (CCN-RCC) in Victoria, British Columbia on June 9-10, 2025. Established in 2020, the CCN-RCC has a vision to establish and guide a coordinated national research and knowledge translation agenda in Canada. This agenda aims to reduce the risk of concussions and their consequences across four broad domains: prevention, detection/diagnosis, prognosis/modifiers, and treatment.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E430-E481"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Traumatic Encephalopathy Syndrome: Head Impact Exposure and Blood Biomarkers in Professional Combat Athletes.","authors":"Brooke D Conway Kleven, Lung-Chang Chien, Chad L Cross, Brian Labus, Charles Bernick","doi":"10.1097/HTR.0000000000001048","DOIUrl":"10.1097/HTR.0000000000001048","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to (1) determine whether there was an association between a diagnosis of traumatic encephalopathy syndrome (TES) and changes in three specific serum biomarkers, and (2) determine head impact exposure thresholds among both TES+ and TES- groups.</p><p><strong>Setting: </strong>Data were collected from Cleveland Clinic's Professional Athletes Brain Health Study (PABHS).</p><p><strong>Participants: </strong>This study included 192 professional combat athletes, 35 years of age and older. Athletes must be actively fighting or retired with a minimum of 10 professional fights over their careers.</p><p><strong>Design/intervention: </strong>This was a retrospective observational study of the PABHS longitudinal cohort.</p><p><strong>Main measures: </strong>The generalized linear model with the generalized estimating equation for repeated measurements was used to compare various biomarkers between both active and retired TES- and TES+ groups.</p><p><strong>Results: </strong>The odds ratio for TES diagnosis was 5.44 (95% CI = 2.48, 11.94; P < .0001) among active fighters and 10.75 (95% CI = 3.52, 32.85; P < .0001) among retired fighters, indicating the odds for a TES diagnosis were over 5 times greater for active fighters with every fight completed at or beyond 30 professional fights. Retired fighters had 10 times greater odds of TES diagnosis with every fight completed at or beyond 15 professional fights. Likewise, the odds of a TES diagnosis were 2.0% (95% CI = 0.3, 3.1; P = 0.0039) greater with each pg/mL increase of glial fibrillary acidic protein (GFAP). No relationship was observed between a TES diagnosis and neurofilament light chain or P-tau231.</p><p><strong>Conclusion: </strong>This study provides preliminary evidence that progressively elevated levels of the GFAP blood biomarker increase the odds of a TES diagnosis among retired professional fighters. Further evaluation is required to improve clarity and understanding of the relationship between progressive changes in the GFAP blood biomarker and a TES diagnosis, specifically evaluating the duration of chronicity and exposure thresholds.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"346-355"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research Letter: Rehabilitation Planning Using Rasch Analysis of the Mayo-Portland Adaptability Inventory, 4th Edition.","authors":"James F Malec","doi":"10.1097/HTR.0000000000001042","DOIUrl":"10.1097/HTR.0000000000001042","url":null,"abstract":"<p><strong>Objective: </strong>To present a method for examining associations among items and total T-score for the Mayo-Portland Adaptability Inventory (4th edition; MPAI-4) that can assist in rehabilitation planning.</p><p><strong>Setting: </strong>Advanced postacute brain injury rehabilitation programs.</p><p><strong>Method: </strong>Description and presentation of a rehabilitation planning guide based on Rasch analysis of the MPAI-4 and application in 2 cases of participants with traumatic brain injury.</p><p><strong>Results: </strong>Initial individualized rehabilitation treatment recommendations derived from examination of the rehabilitation planning guide for specific participants are described.</p><p><strong>Conclusions: </strong>Systematic examination of a visual depiction of associations among MPAI-4 items and total T-score identified through Rasch analysis is useful for rehabilitation planning and in communication and education with participants and families.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"387-392"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143492036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study.","authors":"Maree Cassimatis, Rhonda Orr, Andrew Fyffe, Gary Browne","doi":"10.1097/HTR.0000000000001039","DOIUrl":"10.1097/HTR.0000000000001039","url":null,"abstract":"<p><strong>Objectives: </strong>To determine the relationship between exercise tolerance and post-concussion symptom deficits, cognitive function, and recovery duration; (2) examine the longitudinal effect of exercise tolerance on symptom burden over the clinical timecourse of a child's recovery from concussion; and (3) explicate whether exercise intolerance is a significant determinant of recovery in pediatric concussion.</p><p><strong>Setting: </strong>Pediatric tertiary referral concussion clinic.</p><p><strong>Participants: </strong>Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.</p><p><strong>Design: </strong>Retrospective longitudinal study.</p><p><strong>Main measures: </strong>Graded exercise test (GXT) data, derived from a standardized treadmill test (Bruce Protocol), was used to measure exercise tolerance following concussion. Based on initial GXT times, participants were dichotomized into 2 groups: (1) exercise tolerant (GXT time ≥9 minutes), or (2) exercise intolerant (GXT time <9 minutes). Symptom burden, cognitive function, and recovery duration were compared between groups. A subgroup analysis of participants requiring multiple clinic visitations was conducted to explore the longitudinal effect of post-concussion exercise tolerance over time.</p><p><strong>Results: </strong>Of the 603 children presenting to the concussion clinic, 313 participants (mean age ± SD: 13 ± 2 years, 79% male) were eligible. Exercise-intolerant participants (mean GXT [95% confidence interval, CI], 6.9 [6.5-7.3] minutes) reported 2 times greater initial symptom severity ( P < .001) and performed poorly in visual memory ( P = .002) and reaction time ( P = .02) cognitive domains compared to exercise-tolerant participants (mean GXT [95% CI], 12.3 [12.0-12.5] minutes). Recovery time was longer in exercise-intolerant participants than exercise-tolerant participants (mean recovery time [95% CI], 94 [71-116] vs 69 [57-81] days, P = .002). Participants requiring multiple clinic visitations showed improvements in exercise tolerance and symptom burden over time ( P < .001). Significant predictors of prolonged concussion recovery were delayed presentation time ( P < .001), high initial symptom burden ( P < .001), and exercise intolerance ( P < .001).</p><p><strong>Conclusion: </strong>GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E360-E368"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient and Hospital Factors Associated With Hospital Course for Patients With Mild Traumatic Brain Injury.","authors":"Vikas N Vattipally, Kelly Jiang, Carly Weber-Levine, Patrick Kramer, A Daniel Davidar, Andrew M Hersh, Malcolm Winkle, James P Byrne, Tej D Azad, Nicholas Theodore","doi":"10.1097/HTR.0000000000001056","DOIUrl":"10.1097/HTR.0000000000001056","url":null,"abstract":"<p><strong>Objective: </strong>To characterize variation in the treatment of patients with mild traumatic brain injury (mTBI) who were reasonable candidates for hospitalization, we investigated patient-level associations with inpatient admission and hospital-level associations with length of stay (LOS). We further investigated whether patients treated at high-LOS hospitals were more likely to experience home discharge.</p><p><strong>Setting: </strong>Patients were retrospectively identified from the ACS TQIP dataset.</p><p><strong>Participants: </strong>A total of 122 406 patients with mTBI were included.</p><p><strong>Design: </strong>We performed hierarchical logistic regression to investigate associations of patient-level variables with inpatient admission. Among hospitalized patients, a hierarchical linear regression was constructed for associations with LOS, including hospitals as a random effects term. Based on random effects coefficients, hospitals were classified as high-LOS outliers or non-outliers.</p><p><strong>Main measures: </strong>Univariable comparisons on facility characteristics were performed. Patients were propensity score matched across hospital outlier status, and a multivariable logistic regression for associations with discharge to home was performed.</p><p><strong>Results: </strong>The median age was 63 years (interquartile range [IQR], 42-77 years), and 111 306 (91%) patients experienced inpatient admission. Uninsured status was associated with lower odds of inpatient admission (odds ratio [OR], 0.71; 95% confidence interval [CI], 0.65-0.76; P < .001). After excluding very low-volume hospitals, 80 258 admitted patients were treated across 469 hospitals, and 98 were designated as high-LOS outliers. These were more likely to be Level 1 trauma centers (76% vs. 26%; P < .001). After matching, patients treated at high-LOS outlier hospitals were less likely to experience home discharge (OR, 0.89; 95% CI, 0.85-0.93; P < .001). This effect was amplified for patients identifying as non-White, non-Black, non-Hispanic other races ( P = .003).</p><p><strong>Conclusions: </strong>Inpatient admission after mTBI varies by insurance status, with uninsured patients less likely to be admitted. There is significant interhospital variation in LOS, with Level 1 trauma centers more likely to be high-LOS outliers. Despite their longer LOS, patients treated at outlier hospitals experienced lower odds of home discharge.</p>","PeriodicalId":15901,"journal":{"name":"Journal of Head Trauma Rehabilitation","volume":" ","pages":"E410-E419"},"PeriodicalIF":3.3,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143752902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}