Background Traumatic brain injury (TBI) is a multifaceted condition associated with occupational, social, physical, cognitive, academic, and economic burdens. Mild TBI including traumatic intracranial hemorrhage (tICH), is commonly discharged from the emergency department (ED). Despite the complexity of factors contributing to TBI outcomes, patient education and comprehensive follow-up plans are frequently lacking. We examined health trajectories, recidivism, and follow-up patterns of patients discharged from the ED with tICH to identify opportunities to improve care. Methods We conducted an IRB approved retrospective observational study at a large urban Level 1 trauma center from January 2017 to July 2022. We identified patients (n = 117) discharged from the ED with acute tICH, using IDC 9/10 codes and confirmed by imaging review. Exclusions were hospital admission, chronic ICH, and age under 18. The primary outcome was an ED-revisit within 180 days. Secondary outcomes included any return TBI visit, scheduled specialty TBI provider visit, and post-TBI mental health disorder diagnoses. Age, gender, race, ethnicity, pre-TBI mental health disorders, and socioeconomic status (SES) were analyzed. SES was measured using area deprivation index (ADI). Statistical analysis was performed with logistic regression and Chi-squared tests. Results The average age of enrolled patients was 53 ± 20 years with 39 % female, 26 % Black, 69 % White, and 6 % Hispanic. Overall follow-up rates were low, with 49 % of patients having at least one scheduled follow-up visit within 180 days. Only 16 % of Black patients saw a TBI specialty provider visit within 180 days compared to 36 % of White patients (p = .03). ED recidivism rate was 18 %, with 25 % of patients overall having an unscheduled TBI visit. Lower SES was a significant predictor of any TBI revisit (OR 1.39, CI 1.06, 1.82). New mental health diagnoses following tICH occurred in 15 % of patients; depression and anxiety were most common. There was no association between SES, age, gender, race, or ethnicity and new mental health diagnoses. Conclusion We observed racial and SES differences in follow-up care from the ED for patients with TBI. Individualized discharge planning and formulation of care pathways that account for the mental health and social needs of all patients may improve long-term outcomes. Further understanding of health disparities present in ED TBI care is needed.

BACKGROUND AND OBJECTIVES:The decision to perform a craniotomy (CO) versus decompressive craniectomy (DC) for acute subdural hematomas (aSDH) after traumatic brain injury (TBI) remains challenging. Rotterdam Computed Tomography (RCT) scoring has been shown to correlate with outcome measures in TBI. This study examines the association between RCT scoring and the decision to pursue CO or DC in TBI patients with aSDH. METHODS:A single-center retrospective review was conducted on adult patients who presented with aSDH and received either a CO or DC between 2018 and 2021. Baseline demographics and clinical presentation characteristics were collected. Chi-square, Wilcoxon sum rank test, and t-test were used to compare means. Multivariate stepwise logistic regression models were developed for a predictive model and the receiver operating characteristic curve was analyzed. RESULTS:A total of 126 patients were identified. Patients who underwent DC compared to CO had significantly younger age, higher Injury Severity Scores (ISS), lower Glasgow Come Scale (GCS), and higher RCT scores. After multivariate stepwise logistic regression, GCS and RCT scores greater than or equal to 3 (RCT3) were independently associated with DC in aSDH. Patients with RCT3 were three times more likely to undergo DC (odds ratio 3.22; 95% confidence interval: 1.19-8.67). CONCLUSION:A RCT score of greater than or equal to 3, a younger age, and lower GCS were associated with increased odds of undergoing DC compared to CO for traumatic aSDHs. RCT scores are associated with DC versus CO in patients with aSDH.

Objective:To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI).& nbsp;Design:Cross-sectional analysis of a multicenter cohort study.& nbsp;Setting:National SCI Database.& nbsp;Participants:Individuals with traumatic SCI with follow-up data collected between 2012 and 2018 (N=13,622).& nbsp;Intervention:Not applicable.& nbsp;Main Outcome Measures:Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018.& nbsp;Results:The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (P <.001); those with lower annual income (P <.001), less education (P <.001), non-White race or Hispanic ethnicity (P <.001), or motor incomplete tetraplegia (P=.004); and men (P=.035) were less likely to use the internet from 2012-2018. By 2018, there were no longer differences in internet use based on race and ethnicity (P=.290) or sex (P=.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012-2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (P <.001), income <$50,000 (P <.001), high school diploma or less (P=.011), or non-Hispanic White race/ethnicity (P=.001) were associated with less mobile internet use over time. By 2018, there were no differences in mobile internet use by education (P=.430), and only participants with incomes >$75,000 per year had greater odds of mobile internet use (P=.016).& nbsp;Conclusions:Disparities associated with internet access are decreasing likely as a result of mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI. Archives of Physical Medicine and Rehabilitation 2022;103:832-39 (c) 2021 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

To investigate the association between BAC on admission and neurologic and functional recovery after traumatic SCI.

OBJECTIVE:To report the comprehensive long-term functional and quality of life outcomes after craniectomy (CE) and craniotomy (CO) in individuals with traumatic brain injury (TBI). METHODS:Information on all individuals with TBI who had undergone CE or CO were extracted from the TBI Model Systems database from 2002 to 2012. A 1:1 propensity matching with replacement technique was used to balance the baseline characteristics across groups. The matched sample was analyzed for outcomes during hospitalization, acute rehabilitation, and ≤2 years of follow-up. RESULTS:We identified 1470 individuals who had undergone CE or CO. Individuals undergoing CE compared with CO demonstrated a longer length of stay in the hospital (median, 22 vs. 18 days; P < 0.0001) and acute rehabilitation (median 26 vs. 21 days; P < 0.0001). Individuals with CE had required rehospitalization more often by the 1-year follow-up point (39% vs. 25%; P < 0.0001) for reasons other than cranioplasty, including seizures (12% vs. 8%; P < 0.0001), neurologic events (i.e., hydrocephalus; 9% vs. 4%; P < 0.0001), and infections (10% vs 6%; P < 0.0001). Individuals with CE had significantly greater impairment using the Glasgow Outcome Scale-Extended, required more supervision, and were less likely to be employed at 1 and 2 years after TBI. No difference was observed in the satisfaction with life scale scores at 2 years. The Kaplan-Meier mortality estimates at 1 and 2 years showed no differences between the 2 groups (hazard ratio, 0.57; P = 0.4). CONCLUSION:In a matched cohort, individuals undergoing CE compared with CO after TBI had a longer length of stay, decreased functional status, and more rehospitalizations. The survival at 2 years and the satisfaction with life scale scores were similar.

Shared decision-making (SDM) has been slow to disseminate in mental health. We conducted focus groups with ten individuals with serious mental illness (SMI) treated in a 90day, outpatient transitional care clinic. Parallel groups were held with family caregivers (n = 8). Individuals with SMI wanted longer visits, to have their stories heard, more information about options presented simply, to hear from peers about similar experiences, and a bigger say in treatment choices. Caregivers wanted to be invited to participate to a larger extent. Results suggest that after a decade, SDM may not have the expected penetration in community mental health.

BACKGROUND We previously demonstrated that regionalization of trauma (RT) significantly reduced in-hospital mortality from 19% to 14% in patients with severe traumatic brain injury (sTBI). However, functional and long-term outcomes had not been assessed. We hypothesized that RT would be associated with improved functional and long-term outcomes in sTBI patients. METHODS All TBI patients older than 14 years with a head Abbreviated Injury Scale (AIS) score of 3 or greater were identified from the RT database and matched to the state death index and the regional TBI rehabilitation (TBIr) database. Data from 2008 through 2012 were analyzed before and after RT in 2010. For patients discharged to the TBIr unit, overall Functional Independence Measure (FIM) scores and FIM score gains were compared before and after RT. RESULTS A total of 3,496 patients with sTBI were identified in the RT database, 1,359 in the pre-RT and 2,137 in the post-RT period. The mortality rate after discharge decreased significantly after RT from 21% to 16% (p < 0.0001) at 30 days and from 24% to 20% (p = 0.004) at 6 months. Multivariable logistic regression demonstrated RT to be an independent predictor against mortality at 30 days (odds ratio, 0.74; 95% confidence interval, 0.60–0.91; C statistic, 0.84) and 6 months (odds ratio, 0.82; 95% confidence interval, 0.67–0.99; C statistic, 0.82). Discharges to the TBIr unit increased from 117 (9%) in the pre-RT to 297 (14%) in the post-RT period (p < 0.0001), while discharges to home and non-TBIr units remained similar. Injury Severity Score (ISS) and Glasgow Coma Scale (GCS) score for all discharged patients remained similar. FIM admission scores were similar in the pre-RT (median, 54; interquartile range [IQR], 30–65) and post-RT period (median, 48; IQR, 31–61) (p = 0.2) and remained similar at discharge in the pre-RT (median, 92; IQR, 75–102) and post-RT period (median, 89; IQR, 73–100) (p = 0.1). TBIr patients showed similar FIM score gains in the pre-RT (median, 37; IQR, 26–46) and post-RT period (median, 36; IQR, 24–49) (p = 0.6). CONCLUSION RT was associated with reduced long-term mortality, increased TBIr admissions, and similar FIM score improvements for patients with sTBI. LEVEL OF EVIDENCE Therapeutic/care management study, level IV.

Objective: To assess the prevalence of vitamin D deficiency in patients with traumatic and nontraumatic orthopedic injuries admitted to an inpatient rehabilitation service and to identify demographic and injury-related characteristics that predict variations in serum Vitamin D, 25-OH (VitD-25[OH]) level. Design: Retrospective case series. Setting: Academic inpatient rehabilitation program. Participants: 106 consecutive patients with traumatic and nontraumatic orthopedic injuries admitted to inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: VitD-25(OH) level, patient demographics (age, sex, and race) and injury-related characteristics (etiology, injury site, season- and time since injury). Results: 100 of 106 patients with orthopedic injuries admitted between January 2007 and February 2008 had VitD- 25(OH) concentrations below the optimal value of 30ng/mL. The mean VitD-25(OH) level was 17.1ng/mL with a range from 7.0 to 43.9ng/ml. Blacks had statistically significant lower mean VitD-25(OH) levels compared with whites (14.4 vs 17.7 ng/mL, t=−2.149; P=.034). Lower-extremity amputation was statistically associated with lower mean VitD-25(OH) levels (t=4.050; P<0.001). There was a statically significant difference in mean VitD-25(OH) levels between men and women (18.55 vs 15.37ng/mL, t=−2.22, P<0.028). None of the other variables were associated with VitD-25(OH) levels. Conclusions: The prevalence of VitD-25(OH) deficiency was 94% in this sample of patients with orthopedic injuries. Blacks, lower-extremity amputees, and women may be at higher risk for a greater drop in vitamin D levels. Surveillance of VitD-25(OH) should be part of routine health exams for persons with orthopedic injuries.