Author Affiliations: Departments of Surgery (Drs Davidson and Arbari) (email@example.com) and Pediatrics (Dr Rivara), University of Washington, Seattle.
In Reply: We agree with Dr Rahimi-Movaghar and colleagues that patients discharged to skilled nursing facilities have lower functional and physiological status than those discharged home or to rehabilitation facilities. In addition, patients who are discharged home with assistance typically have more needs than those discharged without assistance. In our study, we adjusted for known confounders, including severity of head injury and functional status, but we were limited by the retrospective nature of our investigation. The question remains whether skilled nursing facilities can improve the long-term outcome of patients who are discharged to their facilities. Our study highlights an area of opportunity to improve outcomes in a group of patients with high mortality rates.
Davidson GH, Rivara FP, Arbabi S. Trauma and Long-term Mortality—Reply. JAMA. 2011;305(23):2413-2414. doi:10.1001/jama.2011.786