Nursing Sensitive Outcomes After Severe Traumatic Brain Injury: A Nationwide Study.

Background: Complications such as infections and conditions after immobilization are frequent after severe traumatic brain injury (TBI) due to compromised bodily functions. Traditionally, bodily functions are core elements in nursing, and therefore nurses in the rehabilitation departments are pivotal in the prevention of complications. Hence, the frequency of complications is an indicator of nursing care quality, which can be included in nursing-sensitive outcome indicators. To do so, it is necessary to know the frequency of the selected complications.

Objective: The aim of this study was to quantify complications during the first year after severe TBI.

Participants: This study included patients 15 years or older who received subacute neurorehabilitation after severe TBI from 2011 to 2015 (N = 469).

Design: This is a register-based follow-up study using data from the Danish Head Trauma Database, a national clinical quality database aimed at monitoring and improving the quality of rehabilitation for patients with severe TBI.

Main Measures: The following complications were assessed: urinary tract infection, pneumonia, pressure ulcers, joint contractures, and deep venous thrombosis. The prevalence of each complication was calculated at admission, discharge, and 1 year postinjury and for the period from admission and during subacute rehabilitation. In addition, the frequency of complications that certainly developed during subacute rehabilitation was calculated. Complications were compared between age-specific subgroups using multivariable binominal regression analyses.

Results: Urinary tract infections (53%) and pneumonia (32%) were the most common complications in the period from admission and during subacute rehabilitation. Pressure ulcers (18%), joint contractures (18%), and deep venous thrombosis (4%) were less frequent. At discharge and 1 year postinjury, the prevalence was less than 4% for all complications, except for joint contractures (16% and 13% at discharge and 1 year postinjury, respectively).

Conclusion: The prevalence of complications was high. The findings are important for future quality improvement of the rehabilitation trajectory and for further studies that explore the high frequency of complications.