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Patient and Hospital Factors Associated With Hospital Course for Patients With Mild Traumatic Brain Injury.

Vikas N Vattipally1, Kelly Jiang, Carly Weber-Levine

  • 1Author Affiliations: Department of Neurosurgery (Mr Vattipally, Ms Jiang, Mr Kramer, and Drs Davidar, Hersh, Azad, and Theodore), Department of Physical Medicine and Rehabilitation (Dr Winkle), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Division of General Surgery, Department of Surgery (Dr Byrne), University of British Columbia, Vancouver, British Columbia, Canada.

The Journal of Head Trauma Rehabilitation
|April 1, 2025
PubMed
Summary

Mild traumatic brain injury (mTBI) treatment varies, with uninsured patients less likely to be admitted. Patients at hospitals with longer lengths of stay (LOS) had poorer home discharge outcomes.

Keywords:
health disparitieshigh-value careinpatient admissionlength of staytraumatic brain injury

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Area of Science:

  • Trauma surgery
  • Health services research

Background:

  • Mild traumatic brain injury (mTBI) management shows significant variation.
  • Patient-level factors and hospital characteristics influence treatment decisions.
  • Understanding these variations is crucial for improving patient outcomes.

Purpose of the Study:

  • To analyze patient-level factors associated with inpatient admission for mTBI.
  • To examine hospital-level factors associated with length of stay (LOS) for mTBI patients.
  • To determine if longer LOS at outlier hospitals impacts home discharge rates.

Main Methods:

  • Retrospective analysis of 122,406 mTBI patients from the ACS TQIP dataset.
  • Hierarchical logistic and linear regression models for admission and LOS.
  • Propensity score matching to compare outcomes at high-LOS outlier hospitals versus others.

Main Results:

  • Uninsured patients had lower odds of inpatient admission (OR 0.71).
  • Level 1 trauma centers were more likely to be high-LOS outliers (76% vs. 26%).
  • Patients at high-LOS outlier hospitals had reduced odds of home discharge (OR 0.89), particularly minority patients.

Conclusions:

  • Inpatient admission for mTBI is influenced by insurance status.
  • Significant interhospital variability exists in LOS, with Level 1 trauma centers often being outliers.
  • Longer LOS at outlier hospitals is associated with worse discharge outcomes, especially for minority populations.