Maryse C. Cnossen, Hester F. Lingsma, Olli Tenovuo, Andrew I.R. Maas, David Menon, Ewout W. Steyerberg, Gerard M. Ribbers, Suzanne Polinder
Center for Medical Decision Sciences, Department of Public Health, Erasmus MC, 3015CN Rotterdam, The Netherlands. E-mail: m.c.cnossen@erasmusmc.nl
DOI: 10.2340/16501977-2216

Objective: To describe variation in structural and process characteristics of acute in-hospital rehabilitation and referral to post-acute care for patients with traumatic brain injury across Europe.
Design: Survey study, of neurotrauma centres.
Methods: A 14-item survey about in-hospital rehabilitation and referral to post-acute care was sent to 71 neurotrauma centres participating in a European multicentre study (CENTER-TBI). The questionnaire was developed based on literature and expert opinion and was pilot-tested before sending out to the centres.
Results: Seventy (99%) centres in 20 countries completed the survey. The included centres were predominately academic level I trauma centres. Among the 70 centres, a multidisciplinary rehabilitation team can be consulted at 41% (n = 29) of the intensive care units and 49% (n = 34) of the wards. Only 13 (19%) centres used rehabilitation guidelines in patients with traumatic brain injury. Age was reported as a major determinant of referral decisions in 32 (46%) centres, with younger patients usually referred to specialized rehabilitation centres, and patients ≥ 65 years also referred to nursing homes or local hospitals.
Conclusion: Substantial variation exists in structural and process characteristics of in-hospital acute rehabilitation and referral to post-acute rehabilitation facilities among neurotrauma centres across Europe.

Variation in rehabilitation practices following traumatic brain injury in Europe
Rehabilitation following traumatic brain injury is important. A questionnaire, sent to 71 European centers, found substantial variation in both in-hospital rehabilitation practice and referral to rehabilitation facilities. For example, only half of the centers had access to a multidisciplinary team for consultation or possessed an in-hospital rehabilitation unit. Further, access to these resources was not uniform - young patients were often referred to specialized rehabilitation centers, whereas patients aged 65 years or older were more likely to be referred to nursing homes and local hospitals. This disparity in access to rehabilitation for older patients is inappropriate, since some previous studies show that elderly patients can make substantial improvement during specialized rehabilitative care. While resource limitation is likely to be important, this large variation might be partly explained by the lack of rehabilitation guidelines in the acute phase of TBI.

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