Examining the accuracy of the AM-PAC "6-clicks" at predicting discharge disposition in traumatic brain injury. (2nd January 2022)

• Record Type: Journal Article
• Authors: Tracy, Brett M; Victor, Melissa; Smith, Randi N; Hinrichs, Mark J; Gelbard, Rondi B
• Is Part Of: Brain injury. Volume 36:Number 1(2022)
• Page Start: 52
• Page End: 58
• Publication Date: 2022-01-02
• Subjects: Functional status -- traumatic brain injury -- postacute care -- length of stay; Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.1080/02699052.2022.2034967
• Languages: English
• ISSNs: 0269-9052

Abstract

ABSTRACT: Objective: To assess the accuracy of the AM-PAC "6-Clicks" in predicting discharge dispositions among severely injured patients with an acute traumatic brain injury (TBI). Methods: We performed a retrospective review of patients with a TBI who presented to our trauma center from 2016 through 2018 and received a "6-Clicks" assessment. Outcomes were hospital length of stay (LOS) and discharge disposition: home, inpatient rehabilitation facility (IRF), subacute location (SL), or death/hospice. Subgroup analyses evaluated patients with concomitant mobility-limiting injuries (CM-LI). Results: There were 432 patients with a TBI; 42.6% (n = 184) had CM-LI. CM-LI patients had lower "6-Clicks" scores compared to patients with an isolated TBI (9 vs 14, p < .0001) and a longer hospital LOS (16.5 d vs 9 d, p < .0001). Increasing "6-Clicks" scores were associated with a home discharge (OR 1.21, 95% CI 1.15–1.28, p < .0001) while decreasing scores were predictive of an IRF or SL discharge or death/hospice. Increasing scores correlated with decreasing hospital LOS for the cohort (β − 8.93, 95% CI −10.24 – −7.62, p < .0001). Conclusion: Among patients with an acute TBI, increasing "6 Clicks" scores were associated with a shorter hospital LOS and greater likelihood of home discharge. Decreasing mobility scores correlated with discharge to an IRF, SL, and death/hospice.