reports

Women are less likely to be admitted for inpatient rehabilitation after hypoxic-ischemic brain injury

Arch Phys Med Rehabil 96:e17-e18.

Toronto Rehabilitation Institute, Toronto, ON, Canada

Objective(s): To investigate demographic and acute care clinical determinants  of admission to inpatient rehabilitation (IR) among hypoxicischemic  brain injury (HIBi) patients who survive the initial acute care episode.

Design: Prospective cohort.

Setting: Ontario, Canada.

Participants: All patients aged 20 years and older with a HIBi in acute  care, identified by specified International Classification of Diseases  Version IO codes, and discharged to IR following acute care discharge  between April 2002 and December 2010 (N=593).
Interventions: NI A.

Main Outcome Measure(s): Admission to IR.

Results: Twenty-eight percent of HIBi survivors were admitted to IR  following discharge from acute care within one year, while 19.6% of  survivors were transferred directly. Of patients admitted to IR, 40.6% had a  HIBi-associated admitting diagnosis, though this proportion was increased  for those admitted directly (55.2% ). A little over half received rehabilitation  specific to non-traumatic acquired brain injury (56.7%), the appropriate  designation for HIBL Younger age, male sex, lower comorbidity  burden, length of stay of preceding acute care episode and markers of  delayed acute care discharge were most predictive of admission to IR in  multivariable regression models. Patients younger than 64 had an 80  percent higher incidence of admission to IR (RR (Relative Risk): 1.78;  95% CI: 1.35-2.35) with the effect strongest for those under 50. Women  had an almost 2-fold (RR: 0.65; 95% CI: 0.49-0.85) lower incidence of  admission to IR.

Conclusions: Older age, higher comorbidity burden, longer lengths of  preceding acute care stay and delayed discharge from acute are significant  barriers to IR admission for HIBi patients. That women are almost 2-fold  less likely to receive rehabilitation treatment is alarming and requires  further investigation in future sex-specific research.