Abstract
To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S. adults, 18–64 years, with primary diagnosis of TBI from 2004–2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Using 266,586 eligible records, LCA resulted in two classes of hospitalizations, namely, class I (n = 217,988) (mostly non-surgical) and class II (n = 48,598) (mostly surgical). Whereas orthopedic procedures were equally likely among latent classes, skin-related, physical medicine and rehabilitation procedures as well as behavioral health procedures were more likely among class I, and other types of procedures were more likely among class II. Class II patients were more likely to have moderate-to-severe TBI, to be admitted on weekends, to urban, medium-to-large hospitals in Midwestern, Southern or Western regions, and less likely to be > 30 years, female or non-White. Class II patients were also less likely to be discharged home and necessitated longer hospital stays and greater hospitalization charges. Surgery appears to distinguish two classes of hospitalized patients with TBI with divergent healthcare needs, informing the planning of healthcare services in this target population.
Highlights
To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S adults, 18–64 years, with primary diagnosis of Traumatic brain injury (TBI) from 2004–2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression
Prevalence rates of procedure groups ranged between 34.0 per 1,000 records for health services that fall under miscellaneous surgeries and 266 per 1,000 records for health services that fall under ophthalmology, otorhinolaryngology and/or respiratory medicine (Table 2)
The heterogeneous nature of TBI and the virtual nonexistence of an “average” TBI patient have prompted the search for novel diagnostic tools including biomarkers as well as hindered the approval of safe and effective therapies by the U.S Food and Drug A dministration[2, 5]
Summary
To characterize latent classes of diagnostic and/or treatment procedures among hospitalized U.S adults, 18–64 years, with primary diagnosis of TBI from 2004–2014 Nationwide Inpatient Samples, latent class analysis (LCA) was applied to 10 procedure groups and differences between latent classes on injury, patient, hospital and healthcare utilization outcome characteristics were modeled using multivariable regression. Traumatic subarachnoid hemorrhage, and/or diffuse axonal injury, necessitating a wide range of diagnostic and/ or treatment procedures within an acute care s etting[1,2,3] These surgical and non-surgical procedures have been previously classified as head elevation, hyperventilation, seizure prophylaxis, medically induced comatose state, therapeutic cooling, intracranial pressure monitoring, craniotomy and decompressive c raniectomy[1]. An examination of how distinct classes of diagnostic and/or treatment procedures tend to cluster may improve our understanding of healthcare needs attributed to TBI The purpose of this cross-sectional study is to perform latent class analyses (LCA) in order to characterize clusters of diagnostic and/or treatment procedures among hospitalized U.S adults, 18–64 years of age, with a primary diagnosis of TBI. Do healthcare utilization outcomes of these latent classes differ by sex, age, race/ethnicity, payer type or urban–rural location?
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