Socioeconomic and clinical factors associated with prolonged hospital length of stay after traumatic brain injury

Abstract

BackgroundHospital length of stay (HLOS) after traumatic brain injury (TBI) is a metric of injury severity, resource utilization, and access to services. This study aimed to evaluate socioeconomic and clinical factors associated with prolonged HLOS after TBI. MethodsRetrospective data from adult hospitalized patients diagnosed with acute TBI at a US Level 1 trauma center between August 1, 2019 - April 1, 2022 were extracted from the electronic health record. HLOS was stratified by Tier (1: 1–74th percentile; 2: 75–84th; 3: 85–94th; 4: 95–99th). Demographic, socioeconomic, injury severity, and level-of-care factors were compared by HLOS. Multivariable logistic regressions evaluated associations between socioeconomic and clinical variables and prolonged HLOS, using multivariable odds ratios (mOR) and [95% confidence intervals]. Estimated daily charges were calculated for a subset of medically-stable inpatients awaiting placement. Statistical significance was assessed at p < 0.05. ResultsIn 1443 patients, median HLOS was 4 days (interquartile range 2–8; range 0–145). HLOS Tiers were 0–7, 8–13, 14–27, and ≥28 days (Tiers 1–4, respectively). Patients with Tier 4 HLOS differed significantly from others, with increased Medicaid insurance (53.4% vs. 30.3–33.1%, p = 0.003), severe TBI (Glasgow Coma Scale 3–8: 38.4% vs. 8.7–18.2%, p < 0.001), younger age (mean 52.3-years vs. 61.1–63.7-years, p = 0.003), low socioeconomic status (53.4% vs. 32.0–33.9%, p = 0.003), and need for post-acute care (60.3% vs. 11.2–39.7%, p < 0.001). Independent factors associated with prolonged (Tier 4) HLOS were Medicaid (mOR = 1.99 [1.08–3.68], vs. Medicare/commercial), moderate and severe TBI (mOR = 3.48 [1.61–7.56]; mOR = 4.43 [2.18–8.99], respectively, vs. mild TBI), and need for post-acute placement (mOR = 10.68 [5.74–19.89], while age was protective (per-year mOR = 0.98 [0.97–0.99]). Estimated daily charges for a medically-stable inpatient was $17126. ConclusionsMedicaid insurance, moderate/severe TBI, and need for post-acute care were independently associated with prolonged HLOS ≥28 days. Medically-stable inpatients awaiting placement accrue immense daily healthcare costs. At-risk patients should be identified early, receive care transitions resources, and be prioritized for discharge coordination pathways.