Retrospective Analysis of Functional and Tracheostomy (Decannulation) Outcomes in Patients with Brain Injury in a Hyperacute Rehabilitation Unit.

Abstract

Objectives: Hyper-Acute Rehabilitation Units (HA-RUs) provide multidisciplinary rehabilitation to patients with acute neurological injuries. This includes managing patients with tracheostomies. This is the first study of its kind to examine clinical outcomes in patients with brain injury and tracheostomy managed in a HARU.

Methods: Retrospective analysis of clinical outcomes in tracheostomy patients admitted to a HARU over a 2-year period.

Results: A total of 208 patients were admitted to the HARU, of whom 99 (60 males and 39 females) had a tracheostomy either at admission or during their stay in the HARU. Mean Glasgow Coma Scale score at admission was 11 (range 5-15) and at discharge was 13 (range 8-15). Mean Functional Independence Measure and Functional Assessment Measure (FIM+FAM) score improved from 52 at admission to 95 at discharge. Mean FIM+FAM cognitive admission cognitive sub-score improved from 23 to 42, and mean motor sub-score from 29 to 42. Changes in scores were deemed to be clinically significant as per thresholds reported in the literature. Of the total patients in this study, 79% were successfully decannulated and 21% needed long-term tracheostomy.

Conclusion: Patients with tracheostomy following brain injury can be appropriately managed in a HARU and show clinically significant improvement in functional outcomes.