Predictors of Extreme Hospital Length of Stay After Traumatic Brain Injury

Yue, John K.; Krishnan, Nishanth; Chyall, Lawrence; Haddad, Alexander F; Vega, Paloma; Caldwell, David J.; Umbach, Gray; Tantry, Evelyne; Tarapore, Phiroz E.; Huang, M.C.Y.; Manley, Geoffrey T.; DiGiorgio, Anthony M

doi:10.1016/j.wneu.2022.08.122

Cited by 11 publications

(13 citation statements)

References 12 publications

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“…Given that males had more severe injuries than females, it is reasonable that they would have a larger proportion of individuals with PLOS. Our findings are consistent with prior studies showing that males accounted for a larger proportion of TBI cohorts and had more severe traumatic injuries than females [ 9 , 10 ].…”

Section: Discussionsupporting

confidence: 93%

“…Our study found no significant difference in LOS as a function of age. The patients in our study were somewhat older, with an average age of 66 years, than other published TBI studies [ 9 , 10 ]. This older cohort reflects the mechanism of TBI as approximately 75% of our cohort had falls as the mechanism of injury, approximately 3% were caused by motor vehicle collisions, and only 9% had an injury due to an intentional or violent mechanism.…”

Section: Discussionmentioning

confidence: 65%

“…In the current literature, the definition of prolonged LOS (PLOS) varies based on the study performed. In studies of TBI patients, authors have used definitions ranging from exceeding the 75th-99th percentile for overall hospital LOS [ 9 , 10 ]. Outside of the TBI literature, other studies have used two standard deviations (SDs) above the mean derived cut-off [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Taylor,

Loo,

Richardson

et al. 2024

Cureus

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Background For traumatic brain injury (TBI) survivors, recovery can lead to significant time spent in the inpatient/rehabilitation settings. Hospital length of stay (LOS) after TBI is a crucial metric of resource utilization and treatment costs. Risk factors for prolonged LOS (PLOS) after TBI require further characterization. Methodology We conducted a retrospective analysis of patients with diagnosed TBI at an urban trauma center. PLOS was defined as the 95th percentile of the LOS of the cohort. Patients with and without PLOS were compared using clinical/injury factors. Analyses included descriptive statistics, non-parametric analyses, and multivariable logistic regression for PLOS status. Results The threshold for PLOS was >24 days. In the cohort of 1,343 patients, 77 had PLOS. PLOS was significantly associated with longer mean intensive care unit (ICU) stays (16.4 vs. 1.5 days), higher mean injury severity scores (18.6 vs. 13.8), lower mean Glasgow coma scale scores (11.3 vs. 13.7) and greater mean complication burden (0.7 vs. 0.1). PLOS patients were more likely to have moderate/severe TBI, Medicaid insurance, and were less likely to be discharged home. In the regression model, PLOS was associated with ICU stay, inpatient disposition, ventilator use, unplanned intubation, and inpatient alcohol withdrawal. Conclusions TBI patients with PLOS were more likely to have severe injuries, in-hospital complications, and Medicaid insurance. PLOS was predicted by ICU stay, intubation, alcohol withdrawal, and disposition to inpatient/post-acute care facilities. Efforts to reduce in-hospital complications and expedite discharge may reduce LOS and accompanying costs. Further validation of these results is needed from larger multicenter studies.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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

Taylor,

Loo,

Richardson

et al. 2024

Cureus

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“…However, this is an unavoidable phenomenon of all cognitive assessment techniques, and failure to complete the assessment can be considered a useful outcome measure in itself. Finally, although the length of Hospital stay represents a surrogate marker of injury severity, 35 we recognise that it can be extended by the presence of polytrauma or other causes of delayed discharge, and consequently, participants’ TBI severity may have been overestimated here. However, as our data were collected retrospectively, other indicators of injury severity, such as length of post-traumatic amnesia, would have been unreliable.…”

Section: Discussionmentioning

confidence: 93%

Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales

Giovane¹,

Trender²,

Bălăeț³

et al. 2023

eClinicalMedicine

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“…The use of mean ICP to calculate the thresholds received criticism [ 26 , 30 ] as severe TBI tends to be associated with long durations of ICU and hospital stay [ 45 , 51 ] and, by inference, durations of ICP monitoring. As ICP can vary substantially over time, the subsequent monitoring period might encompass a period with ICP values in the normal area and as a result, the mean ICP alone might reflect a tail of normalised ICP values.…”

Section: Discussionmentioning

confidence: 99%

Critical ICP thresholds in relation to outcome: Is 22 mmHg really the answer?

Riparbelli,

Capion,

Møller

et al. 2024

Acta Neurochir

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Purpose Intensive care for patients with traumatic brain injury (TBI) aims, among other tasks, at avoiding high intracranial pressure (ICP), which is perceived to worsen motor and cognitive deficits and increase mortality. International recommendations for threshold values for ICP were increased from 20 to 22 mmHg in 2016 following the findings in a study by Sorrentino et al., which were based on an observational study of patients with TBI of averaged ICP values. We aimed to reproduce their approach and validate the findings in a separate cohort. Methods Three hundred thirty-one patients with TBI were included and categorised according to survival/death and favourable/unfavourable outcome at 6 months (based on Glasgow Outcome Score—Extended of 6–8 and 1—5, respectively). Repeated chi-square tests of survival and death (or favourable and unfavourable outcome) vs. high and low ICP were conducted with discrimination between high and low ICP sets at increasing values (integers) between 10 and 35 mmHg, using the average ICP for the entire monitoring period. The ICP limit returning the highest chi-square score was assumed to be the threshold with best discriminative ability. This approach was repeated after stratification by sex, age, and initial Glasgow Coma Score (GCS). Results An ICP limit of 18 mmHg was found for both mortality and unfavourable outcome for the entire cohort. The female and the low GCS subgroups both had threshold values of 18 mmHg; for all other subgroups, the threshold varied between 16 and 30 mmHg. According to a multiple logistic regression analysis, age, initial GCS, and average ICP are independently associated with mortality and outcome. Conclusions Using identical methods and closely comparable cohorts, the critical thresholds for ICP found in the study by Sorrentino et al. could not be reproduced.

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Predictors of Extreme Hospital Length of Stay After Traumatic Brain Injury

Cited by 11 publications

References 12 publications

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

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

Computerised cognitive assessment in patients with traumatic brain injury: an observational study of feasibility and sensitivity relative to established clinical scales

Critical ICP thresholds in relation to outcome: Is 22 mmHg really the answer?

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