Department of Surgery, MetroHealth Medical Center, Cleveland, Ohoi.
Department of Surgery, MetroHealth Medical Center, Cleveland, Ohoi; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Surg Res. 2022 Mar;271:98-105. doi: 10.1016/j.jss.2021.10.023. Epub 2021 Dec 4.
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.
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.
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.
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.
创伤性脑损伤（TBI）后的出院地点可能受到非患者因素的影响，例如区域或机构的实践模式。我们假设非患者因素与严重 TBI 患者的出院地点有关。
ACS 创伤质量改进计划 2016 数据集的所有严重 TBI 患者（定义为头部简明损伤量表≥3）均按出院地点分类。使用逻辑回归评估与每个目的地相关的因素；报告比值比和 95%置信水平。回归调整了年龄、性别、种族、保险、GCS、ISS、多发伤、机制、神经外科手术、地理位置、教学状态、创伤中心级别、医院规模和神经外科医生组规模。
75690 名患者符合纳入标准。51%出院回家，16%出院康复，14%出院康复，11%死亡。死亡率在地理区域、教学状态和医院规模方面相似。南部地区的患者更有可能出院回家，而东北部地区的患者更有可能出院康复。由 3 名或更多神经外科医生治疗的患者更有可能被送往 SNF，在社区或非教学医院治疗的患者也是如此。在较大医院接受治疗的患者不太可能出院康复，更有可能前往 SNF。
地理位置、神经外科医生组规模、教学状态和医院规模与严重 TBI 后出院地点的变化显著相关。实践模式的区域和机构差异可能对某些严重 TBI 患者的康复起着重要作用。
