Patient Factors Associated With Prolonged Length of Stay After Traumatic Brain Injury.

Area of Science:

• Neuroscience
• Trauma Surgery
• Health Services Research

Background:

• Traumatic brain injury (TBI) survivors require extensive inpatient and rehabilitation care.
• Hospital length of stay (LOS) is a key indicator of resource utilization and cost in TBI recovery.
• Identifying risk factors for prolonged LOS (PLOS) after TBI is essential for optimizing patient care and resource management.

Purpose of the Study:

• To characterize the clinical and injury-related risk factors associated with prolonged hospital length of stay (PLOS) in traumatic brain injury (TBI) survivors.
• To identify predictors of PLOS using multivariable logistic regression analysis.

Main Methods:

• Retrospective analysis of 1,343 TBI patients admitted to an urban trauma center.
• PLOS defined as the 95th percentile of LOS (>24 days).
• Comparison of clinical/injury factors between patients with and without PLOS using descriptive statistics, non-parametric analyses, and multivariable logistic regression.

Main Results:

• PLOS was associated with longer intensive care unit (ICU) stays, higher injury severity scores, lower Glasgow Coma Scale scores, and greater complication burden.
• Patients with PLOS were more likely to have moderate/severe TBI, Medicaid insurance, and less likely to be discharged home.
• Predictors of PLOS included ICU stay, inpatient disposition, ventilator use, unplanned intubation, and inpatient alcohol withdrawal.

Conclusions:

• TBI patients experiencing PLOS often present with severe injuries, in-hospital complications, and specific insurance types (Medicaid).
• Key predictors for PLOS include ICU stay, intubation requirements, alcohol withdrawal, and disposition to post-acute care facilities.
• Interventions aimed at reducing in-hospital complications and facilitating timely discharge may decrease LOS and associated healthcare costs.