Using clinical quality databases to monitor the quality of fundamental care: Example with weight status after severe traumatic brain injury

AIM: To determine weight status and risk of overweight up to one year after severe traumatic brain injury (TBI) as basis for defining nursing sensitive indicators of fundamental nutritional nursing care in a clinical quality database.

BACKGROUND: Patients´ nutritional needs are recognized as fundamental care during hospitalization, but less attention has been given to nutritional status after discharge.

DESIGN: Nationwide cohort study. The STROBE checklist was used to ensure reporting quality.

METHODS: Data were retrieved from the Danish Headtrauma Database, a clinical quality database aiming at improving the quality of neurorehabilitation. Individuals aged ≥15 years with severe TBI 2011-2015 (N=424) were included. Normal weight, underweight and overweight was described according to the Body Mass Index (BMI) at admission to subacute rehabilitation, at discharge and at 1-year post-injury. The probability of transition between weight groups from admission to 1-year post-injury was calculated. Multivariable binominal regression analyses compared risk of overweight between age-groups.

RESULTS: The prevalence of underweight decreased from 13% at admission to 6% and 3% at discharge and 1-year post-injury, respectively. The prevalence of overweight was stable at 26% -27% at admission and discharge and increased to 44% at 1-year post-injury. Of the individuals not overweight at admission, 28% became overweight by 1-year post-injury. Overweight was significantly more prevalent in older compared to younger individuals. The risk of becoming overweight among those not overweight at admission did not differ between age-groups.

CONCLUSION: Underweight individuals achieved normal weight during inpatient rehabilitation. By one-year post-injury, individuals were increasingly overweight.

RELEVANCE TO CLINICAL PRACTICE: Weight status has potential as nursing-sensitive indicators that may be included in clinical quality databases to inform the organizational and policy level on the state of fundamental nutritional nursing care. The inclusion emphasise requested responsibilities of nursing care. This facilitates health economic attention and influences nursing professional execution.