402 Disparities in Traumatic Brain Injury Patients’ Length of Stay: An Analysis of NTDB Data

Abstract

INTRODUCTION: Traumatic brain injury (TBI) presents a disproportionate biopsychosocial and economic burden on certain patient populations compared to others. Inpatient length of stay (LOS) emerges as a proxy measure of injury severity, resource utilization, and access to post-acute care. Identifying determinants of prolonged LOS following TBI admission allows for the evaluation of disparities in care. METHODS: The NTDB compiles trauma registry data across various U.S. trauma centers. Our study’s inclusion criteria were adult patients who were admitted after a TBI. xLOS was defined as 99th percentile or greater LOS. Patients with xLOS were compared to patients below the xLOS threshold (sLOS). A generalized losgistic regression analysis was performed to assess the effect of covariates on xLOS. RESULTS: 257,836 patients were included and the mean, median and IQR LOS were 7.1 days, 4.0d and 1-7d, resepectively. The xLOS threshold was ≥49d (range: 49–357d). xLOS patients, compared to sLOS, were more often associated with Medicaid insurance (32.5% vs. 13.5%.; p<0.001), a lower age quintile (29–46 years: 30.3% vs. 20.3%; 47–60 years: 29.9% vs. 20.5%; p<0.001), and greater injury severity (moderate :19.8% vs. 4.7%; severe: 47.6% vs. 5.2%; p<0.001). The xLOS were also more commonly Black (22.2% vs. 13.5%; p< 0.001) and hispanic (8.8% vs. 5.4%; p < 0.001). Fewer xLOS patients were discharged home (17.4% vs. 61.8%; p< 0.001). Multivariate analysis showed that xLOS is associated with younger age, greater injury severity, discharge to post-acute facillities, and, Medicaid or self-pay insurance. Relative to non-hispanic whites, Black(OR: 1.45; p< 0.001), Hispanic (OR: 1.54; p < 0.001), and Asian(OR: 1.32; p = 0.02) patients are more likely have xLOS. CONCLUSIONS: There are multiple socioeconomic factors that dispose patients to xLOS after TBI, even when adjusting for injury severity. Examining the heterogeneity of LOS within demographic categories provides one avenue to evaluate disparities in TBI care.