When should I refer a patient with a traumatic brain injury to a specialist rehabilitation service?

Refer a patient with a traumatic brain injury to a specialist rehabilitation service as soon as possible after the injury, ideally starting rehabilitation when the person is ready and able to engage and participate. This includes early assessment of rehabilitation needs as an integral part of their care pathway from admission, using a person-centred, individualised, and holistic approach regardless of injury severity.

Use validated tools such as the rehabilitation complexity scale (RCS), patient categorisation tool (PCAT), complex needs checklist (CNC), or post-ICU presentation screen (PICUPS) to determine the need for early referral to specialist rehabilitation units.

Involve rehabilitation specialists, ideally including a consultant in rehabilitation, alongside acute care teams early on to discuss rehabilitation implications and goals with the patient and their family or carers.

Immediate psychological and emotional support should be provided, and additional psychology services requested as needed.

Referral is particularly important when the patient has complex rehabilitation needs that may not correlate directly with injury severity, and when physical impairments affect activities of daily living requiring occupational therapy input.