Injury severity and disability in the selection of next level of care following acute medical treatment for traumatic brain injury

James F. Malec, Jayawant Mandrekar, Allen W Brown, Anne M. Moessner

Research output: Contribution to journalArticle

6 Scopus citations


Primary objective: To evaluate the association of demographic factors, post-traumatic amnesia (PTA) and a standardized measure of ability limitations with clinical decisions for Next Level of Care following acute hospital treatment for moderate-severe traumatic brain injury (TBI). Research design: A TBI Clinical Nurse specialist recorded PTA for 212 individuals and rated 159 on the Ability and Adjustment Indices of the Mayo-Portland Adaptability Inventory (MPAI-4) for comparison with clinical decisions. Main outcomes and results: Multivariate logistic regression analyses revealed that independent ratings on the MPAI-4 Ability Index and PTA were associated with the clinical decision to admit to Inpatient Rehabilitation vs discharge to Home in 92.7% of the sample; ratings on the Ability Index alone were associated with this decision in 92.2% of cases. Age over 65 was the only variable associated with discharge to a Skilled Nursing Facility, correctly predicting this decision in 64% of cases. Conclusions: Use of a standardized measure of ability limitations appears feasible to provide supportive documentation and potentially improve the consistency of decision-making in recommending Inpatient Rehabilitation vs discharge to Home. Although age is a significant factor in the decision to discharge to a Skilled Nursing Facility, this decision appears complex and merits further study.

Original languageEnglish (US)
Pages (from-to)22-29
Number of pages8
JournalBrain Injury
Issue number1
StatePublished - 2009



  • Brain Injury
  • Medical decision-making
  • Rehabilitation

ASJC Scopus subject areas

  • Clinical Neurology

Cite this