Lost in Transition: Long-term Follow-up in Traumatic Brain Injury Patients

Traumatic brain injury (TBI) is a significant public health problem with patients frequently suffering long-term neurologic, psychiatric, and cognitive symptoms. Systematic outpatient follow-up after hospital discharge is critical for identifying residual deficits and improving functional outcomes. We hypothesize that the majority of TBI patients do not engage in routine outpatient follow-up after their index admission and may not receive ancillary services necessary for long-term recovery.

We conducted a retrospective, single-center analysis of all admitted TBI patients between January 2022 and January 2024. Patients with radiographically confirmed TBI who were expected to survive to follow-up were included. Chart reviews determined post discharge appointments and referrals to ancillary services, including physical therapy, occupational therapy, speech-language pathology, and neurocognitive testing.

Among 1142 TBI patients, 605 (53%) returned for outpatient follow-up. Of those, 543 (89.8%) patients were seen in neurosurgery clinic, primarily for repeat imaging and/or post surgical care. Clinic documentation rarely discussed quality of life, cognitive deficits, or behavioral changes, and ancillary referrals were infrequent (<2%). In multivariate analysis, discharge to a nonrehabilitative facility (odds ratio (OR): 0.541, P < 0.001) and uninsured status (OR 0.591, P = 0.016) were independently associated with decreased likelihood of follow-up. Higher Abbreviated Injury Scale Head scores (OR 1.446, P < 0.001) and decompressive craniectomy (OR 2.867, P = 0.003) were associated with increased likelihood of follow-up.

Nearly half of TBI patients did not receive outpatient follow-up after discharge, and utilization of ancillary services was low, revealing significant gaps in post acute care. Targeted strategies to improve post discharge follow-up are essential to support long-term recovery in this vulnerable population.