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. 2022 Mar:271:98-105.
doi: 10.1016/j.jss.2021.10.023. Epub 2021 Dec 4.

Variations in Discharge Destination Following Severe Traumatic Brain Injury across the United States

Samuel P Stanley  1 , Evelyn I Truong  1 , Belinda S DeMario  1 , Husayn A Ladhani  1 , Esther S Tseng  1 , Vanessa P Ho  2 , Michael L Kelly  3
Affiliations

Variations in Discharge Destination Following Severe Traumatic Brain Injury across the United States

Samuel P Stanley et al. J Surg Res. 2022 Mar.

Abstract

Background: Discharge destination after traumatic brain injury (TBI) may be influenced by non-patient factors such as regional or institutional practice patterns. We hypothesized that non-patient factors would be associated with discharge destination in severe TBI patients.

Methods: All patients in the ACS Trauma Quality Improvement Program 2016 data set with severe TBI, defined as head Abbreviated Injury Scale ≥3, were categorized by discharge destination. Logistic regression was used to assess factors associated with each destination; odds ratios and 95% confidence level are reported. Regressions were adjusted for age, gender, race, insurance, GCS, ISS, polytrauma, mechanism, neurosurgical procedure, geographic region, teaching status, trauma center level, hospital size, and neurosurgeon group size.

Results: 75,690 patients met inclusion criteria. 51% were discharged to home, 16% to rehab, 14% to SNF, and 11% deceased. Mortality was similar across geographic region, teaching status, and hospital size. Southern patients were more likely to be discharged to home while Northeastern patients were more likely to be discharged to rehab. Treatment by groups of 3 or more neurosurgeons was associated with SNF discharge as was treatment at community or non-teaching hospitals. Patients treated at larger hospitals were less likely to be discharged to rehab and more likely to go to SNF.

Conclusions: Geographic region, neurosurgeon group size, teaching status, and hospital size are significantly associated with variation in discharge destination following severe TBI. Regional and institutional variation in practice patterns may play important roles in recovery for some patients with severe TBI.

Keywords: Discharge destination; Practice variation; Trauma center; Traumatic brain injury.

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Conflict of interest statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

VPH is supported by the Clinical and Translational Science Collaborative of Cleveland (KL2TR002547) from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health and NIH roadmap for Medical Research.

VPH spouse is a consultant for Zimmer Biomet, Medtronic, Sig Medical, and Atricure.

Figures

Figure 1:
Figure 1:
Inclusion and Exclusion Criteria.
See this image and copyright information in PMC

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