Care Wards Research Articles

Factors Associated with Mortality in Nosocomial Lower Respiratory Tract Infections: An ENIRRI Analysis

Background: Nosocomial lower respiratory tract infections (nLRTIs) are associated with unfavorable clinical outcomes and significant healthcare costs. nLRTIs include hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and other ICU-acquired pneumonia phenotypes. While risk factors for mortality in these infections are critical to guide preventive strategies, it remains unclear whether they vary based on their requirement of invasive mechanical ventilation (IMV) at any point during the hospitalization. Objectives: This study aims to identify risk factors associated with short- and long-term mortality in patients with nLRTIs, considering differences between those requiring IMV and those who do not. Methods: This multinational prospective cohort study included ICU-admitted patients diagnosed with nLRTI from 28 hospitals across 13 countries in Europe and South America between May 2016 and August 2019. Patients were selected based on predefined inclusion and exclusion criteria, and clinical data were collected from medical records. A random forest classifier determined the most optimal clustering strategy when comparing pneumonia site acquisition [ward or intensive care unit (ICU)] versus intensive mechanical ventilation (IMV) necessity at any point during hospitalization to enhance the accuracy and generalizability of the regression models. Results: A total of 1060 patients were included. The random forest classifier identified that the most efficient clustering strategy was based on ventilation necessity. In total, 76.4% of patients [810/1060] received IMV at some point during the hospitalization. Diabetes mellitus was identified to be associated with 28-day mortality in the non-IMV group (OR [IQR]: 2.96 [1.28–6.80], p = 0.01). The 90-day mortality-associated factor was MDRP infection (1.98 [1.13–3.44], p = 0.01). For ventilated patients, chronic liver disease was associated with 28-day mortality (2.38 [1.06–5.31] p = 0.03), with no variable showing statistical and clinical significance at 90 days. Conclusions: The risk factors associated with 28-day mortality differ from those linked to 90-day mortality. Additionally, these factors vary between patients receiving invasive mechanical ventilation and those in the non-invasive ventilation group. This underscores the necessity of tailoring therapeutic objectives and preventive strategies with a personalized approach.

Prospective Observational Study of De-Escalation of Empirical Antibiotics in Fiji’s National Hospital

Background: Antimicrobial resistance is a global health threat and Fiji is not exempt. The appropriate prescribing and timely de-escalation of antibiotics as an integral component of antimicrobial stewardship has been recently introduced in Fiji to help curb antimicrobial resistance through de-escalation, leading to a reduced opportunity for the induction of resistance. Objectives: To assess whether empirical antibiotics are being adjusted in a timely fashion in patients admitted with a diagnosis of suspected infection in the Colonial War Memorial Hospital( CMWH) over three months. Method: The study was undertaken on patients admitted to the acute medical ward and intensive care unit of the CWMH in Suva (Fiji’s largest hospital). A total of 474 patients were prospectively enrolled at admission when prescribed empiric antibiotic therapy for suspected infections between February and April 2019. Results: A total of 356 patients admitted to the Acute Medical Ward and 118 admitted to the Intensive Care Unit were prescribed empiricalantibiotics. These 474 patients were prospectively observed to determine the factors influencing the extent and the timing of antibiotic de-escalation. Only 137 (29%) patients had their antibiotic regimen de-escalated in the first 72 h post-admission based on their microbiological results, whereas, 207 (42%) were de-escalated more than 72 h after admission (OR = 0.5, 95% CI 0.3–0.89; p < 0.016). Conclusions: At CWMH, antibiotic de-escalation is slow and may be improved by quicker laboratory reporting, greater access to laboratory results for prescribers, and the availability of a wider range of narrow-spectrum antibiotics to assist de-escalation.

Social suffering among older adults with terminal cancer in hospice care wards in Shanghai: a qualitative study

ABSTRACT As the number of older patients increases, it is important that the quality of end-of-life care must also be enhanced. This study qualitatively explored the negative experiences of older patients in Chinese hospice care wards. We interviewed 21 participants whose estimated survival time was less than three months. Participants reported negative experiences in terms of social roles, social relations, family burden, hospital environment, and social background factors. Such negative experiences were self-constructed and based on a family-centred concept unique to the Chinese culture. We proposed an intervention framework for clinical social workers during the initial development stage of hospice care in the Asia Pacific region.

Differences in Characteristics of Peripartum Patients Who Did and Did Not Require an Upgrade to the Intensive Care Unit: A Propensity Score Matching Study.

Background and Objectives: This study sought to identify predictors for peripartum patients admitted to non-intensive care wards who later upgraded to the Intensive Care Unit (ICU). Materials and Methods: This was a retrospective observational study of patients admitted to the Maternal Fetal Ward between 01/2017 and 12/2022, who later upgraded to the ICU. Upgraded patients were 1:1 propensity score matched with those who remained on the Maternal Fetal Ward (control). The Classification And Regression Tree, a machine learning algorithm, was used to identify significant predictors of ICU upgrade. Multivariable ordinal regression analysis was used to assess the time interval to upgrade. Results: From 1855 peripartum patients, we analyzed 37 control and 34 upgrade patients. Mean maternal age (±Standard Deviation) and gestational age for the group was 29.5 (±5.8) years and 31.5 (±7.5) weeks, respectively. The Median Sequential Organ Failure Assessment Score [Interquartile] at ward admission for the controls was 0 [0-1] versus 2 [0-3.3, p = 0.001] for upgrade patients. The Sequential Organ Failure Assessment score at Maternal Fetal Ward admission was most predictive, followed by the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and lactate dehydrogenase levels. The APACHE II score was also associated with ICU upgrade within 12 h of hospital admission (OR 1.4, 95% CI 1.08-1.91, p = 0.01). Conclusions: Compared to control patients, peripartum patients upgraded to the ICU are associated with higher physiologic scores at Maternal Fetal Ward admission. Until further studies are performed to confirm our observation, clinicians should pay attention to these physiologic scores, since they may be associated with higher-risk patients.

An Overlooked Challenge: A Retrospective Audit of Overnutrition in Hospital Rehabilitation Wards.

Background/Objective: Research shows that obesity has risen among rehabilitation patients. Despite this, nutrition care in subacute rehabilitation wards focuses primarily on preventing and treating protein-energy malnutrition. The continued provision of energy-dense meals during lengthy rehabilitation admissions may present a risk of overnutrition for some patients, which can adversely affect functional outcomes. However, overnutrition is not routinely monitored in practice. This study summarizes the initial findings of a multi-site investigation of overnutrition incidence across five rehabilitation wards to scope the need for future research. Methods: A retrospective audit was conducted, including all inpatients admitted over 3 months to the study wards with a complete dataset (total sample n = 199). Data were collected from the medical record and menu management system to determine overnutrition, defined as an average daily energy intake equal to or greater than 1000 kJ above estimated requirements and weight gain of equal to or greater than 1 kg over the admission. Results: The incidence of overnutrition in the total sample was 12.1%. Of those patients deemed at low risk of malnutrition (n = 124), 19.4% developed overnutrition during their rehabilitation admission. Those who developed overnutrition during their admission gained an average of 2.9 kg, with a mean excess energy intake of 2456 kJ/day above estimated requirements. They also consumed a high intake of discretionary items (mean of 3156 kJ/day). Conclusions: The findings suggest that further research is needed to investigate the etiology and impact of the overlooked problem of overnutrition in subacute rehabilitation settings. Future investigation is essential to ensure that the planning and delivery of subacute dietetic and food services meet the nutrition needs of patients in longer-stay inpatient settings.

Impact of an electronic surveillance system on compliance with isolation precaution measures: an interrupted time series study

Background Electronic surveillance systems (ESSs) may assist infection prevention and control (IPC) teams in detecting and monitoring patients infected or colonised by pathogens to prevent healthcare-associated infections. We aimed to assess the impact of implementing an ESS on compliance with isolation precaution measures for bacterial infections or colonizations. Methods A quasi-experimental before-after study was conducted using interrupted time series analysis from 1 March 2018 to 31 July 2024 at the University Hospital of Nancy (France). The ESS was implemented in October 2022. The results of audits conducted by IPC nurses to investigate isolation measures for inpatients that required isolation precautions were aggregated monthly. Results 1379 audits were included in the study. The implementation of the ESS had no significant immediate impact on isolation measures, except for an increase in the presence of adequate hand hygiene products (+10.1%, p < 0.01). After the COVID-19 period, all isolation measures decreased. The implementation of the ESS was associated with positive changes in trends of isolation measures, particularly for the prescription of isolation precautions (+1.1%/month, p < 0.01), the isolation signage (+1.2%/month, p < 0.001), the hand hygiene products (+0.8%/month, p < 0.01), and full compliance with isolation measures (+1.1%/month, p < 0.0001). The audit rate significantly increased in the first 7 months of ESS use but then decreased. Conclusions The positive impact of ESS on compliance with isolation measures was likely due to the increased presence and communication of the IPC team in care wards, which was facilitated by the time saved in the surveillance and detection of carriers through the ESS.

Prognostic impact of psychoeducation program completion on inpatients with schizophrenia: a pilot cohort study

BackgroundPsychoeducation programs can reduce the risk of recurrence and readmission in patients with schizophrenia. However, almost all previous studies of program efficacy have included only patients completing the program, which may not be possible in all cases. The objective of this pilot cohort study was to compare the prognoses of inpatients with schizophrenia who did or did not complete a well-established institutional psychoeducation program.MethodsThis study is a pilot cohort study, and the participants were 32 inpatients in the psychiatric acute care ward. Among these patients, 18 completed the institutional psychoeducation program by discharge, whereas 14 missed one or more sessions for various reasons. The primary outcome was the duration of outpatient treatment (DOT) during the 5-year follow-up period, and the secondary outcomes were comparisons of the risk of all-cause discontinuation for outpatient treatment and correlations between the program participation rates and DOT.ResultsDOT was significantly longer in the program completion group than in the noncompletion group (918.2 (174.3) days vs. 225.5 (35.7) days, p = 0.001), and multivariate Cox proportional hazards regression analysis revealed that program noncompliance was associated with a 4.450-fold (p = 0.002) greater risk of discontinuation of outpatient treatment according to multivariate analysis. A significant weak correlation was found for DOT and rates of sessions admitted to the programme (Pearson's r = 0.384, p = 0.030).ConclusionsCompletion of a psychoeducation program could enhanced the success of outpatient treatment. As psychoeducation and related factors may have a positive effect of the prognosis after discharge, inpatient psychoeducation programs should be flexible enough to provide opportunities for completion.

Blood Culture Use in Medical and Surgical Intensive Care Units and Wards

Blood culture (BC) use benchmarks in US hospitals have not been defined. To characterize BC use in adult intensive care units (ICUs) and wards in US hospitals. A retrospective cross-sectional study of BC use in adult medical ICUs, medical-surgical ICUs, medical wards, and medical-surgical wards from acute care hospitals from the 4 US geographic regions was conducted. Critical access hospitals, less than 6 months of BC data, and non-US hospitals were excluded. The study included BC use data from September 1, 2019, to August 31, 2021. Data were analyzed from February 23 to July 14, 2024. The primary outcome was BC use per 1000 patient-days. Adjusted means with 95% CIs were calculated using mixed-effects negative binomial regression models adjusted for unit type, hospital bed size, geographic region, seasonality, and state COVID-19 case load, with random intercepts accounting for clustering at unit and hospital levels. Secondary outcomes included blood culture positivity, single BCs, BC contamination, and minimum threshold for BC use where blood culture positivity would be optimized. A total of 362 327 blood cultures were analyzed from 27 medical ICUs, 35 medical-surgical ICUs, 121 medical wards, and 109 medical-surgical wards from 48 hospitals in 19 states and the District of Columbia. The adjusted mean BC use per 1000 patient-days was 273.1 (95% CI, 270.2-275.9) for medical ICUs, 146.0 (95% CI, 144.5-147.5) for medical-surgical ICUs, 80.3 (95% CI, 79.8-80.7) for medical wards, and 65.1 for medical-surgical wards. Blood culture use was significantly higher across all 4 unit types in hospitals with more than 500 beds compared with 500 or less beds and in the West-Midwest compared with other regions. Single blood culture and positive blood culture rates were below 10% across all 4 unit types. Of the 292 units, 97% had a mean BC contamination rate within 3% of the recommended threshold, and 51% were within 1%. The minimum BC use thresholds (ie, BC use below this number may represent undertesting) were 120 BCs per 1000 patient-days for medical ICUs, 80 BCs per 1000 patient-days for medical-surgical ICUs, and 30 BCs per 1000 patient-days for medical-surgical wards. The findings of this study suggest that blood culture positivity may help determine appropriate BC use for individual unit types.

Accuracy of Continuous Glucose Monitoring in Adults with Type 1 Diabetes Admitted to Hospital: A Real-World Multicenter Observational Study.

Introduction: Continuous glucose monitoring (CGM) use in people with type 1 diabetes (T1D) is revolutionizing management. Use of CGM in hospital is poised to transform care, however routine use is not currently recommended due to lack of accuracy validation in acute care, including in people with T1D. We aimed to determine real-world CGM accuracy in hospitalized adults with T1D. Materials and Methods: In this multicenter retrospective observational study, we compared CGM interstitial fluid glucose with reference blood glucose (capillary/whole-blood point-of-care [POC], blood gas [GAS]) in adults with T1D requiring multiday admissions during 2020-2023 across three health services in Australia. Patients requiring dialysis or admitted under pediatric/obstetric/palliative care/psychiatry units were excluded. CGM accuracy was assessed by comparison with time-matched (±5 min) reference glucose measures, utilizing median absolute relative difference (ARD), mean ARD (MARD), and consensus error grid (CEG) analysis. Results: In total, 2,199 CGM-reference glucose pairs from 214 admissions (146 patients) were assessed. Overall, mean (SD) ARD was 12.8% (13.1) and median (IQR) ARD was 9.4% (3.7-17.7). MARD for CGM-POC pairs was 12.3%; MARD for CGM-GAS pairs was 14.3%. In CEG analysis, 99.3% of glucose pairs were within zones A/B. Accuracy was lower in critical care compared with noncritical care wards (MARD 16.1% vs. 12.0%, P < 0.001). Conclusions: In this real-world multicenter study, CGM glucose agreed well with reference blood glucose, suggesting modern CGM devices could be safely and effectively used in hospitalized adults with T1D. Further prospective studies of CGM accuracy with newer generation devices across different scenarios will further elucidate inpatient CGM accuracy and safety.

Factors predictive of serum cortisol in pediatric patients with acute physiological stress: a cohort study.

Measuring cortisol is crucial for assessing adrenal function in patients under stress; however, its value can fluctuate owing to various clinical factors. This study aimed to identify predictors of cortisol levels in pediatric patients with acute physiological stress. Children who were urgently admitted to the general ward or pediatric intensive care unit for acute illness or postoperative care were enrolled, while those with suspected adrenal function abnormalities or on current steroid therapy were excluded. Cortisol was measured in serum samples collected within 72 h of registration and its association with clinical factors was explored. A total of 397 samples from 217 patients were analyzed between August and November 2021 showing a median cortisol level of 375 nmol/L (interquartile range: 190-646 nmol/L). Multiple regression analysis with a mixed-effects model identified the following predictors of higher cortisol levels: heart rate z-score (+43.8 nmol/L/point), body temperature (+42.3 nmol/L/°C), Pediatric Early Warning System score (+44.3 nmol/L/point), age 3-6 yr (+68.8 nmol/L vs. < 1 yr), elapsed time < 4 h (+130.9 nmol/L vs. 4-12 h), and sampling time 6-10 AM (+96.4 nmol/L vs. 10 AM-2 PM). These variables independently predicted cortisol levels in pediatric patients during acute physiological stress.

Successful recovery of 85% TBSA burns in a resource-limited Nigerian hospital without a burns ward or intensive care unit: A case report

Successful recovery of 85% TBSA burns in a resource-limited Nigerian hospital without a burns ward or intensive care unit: A case report

Retrospective observational study of the association of peak blood glucose during the second 24 hours of admission with hospital-acquired complications in non-critical care admissions to a tertiary referral teaching hospital

IntroductionStress hyperglycaemia at hospital presentation is associated with poorer outcomes. Less is known about the risk of poorer outcomes according to achieved glycaemia early in the admission.Research design/methodsThis was a...

Heterogeneity of Intermediate Care Organization Within a Single Healthcare System.

Intermediate care (IC) is prevalent nationwide, but little is known about how to best organize this level of care. Using a 99-item cross-sectional survey assessing four domains (hospital and physical IC features, provider and nurse staffing, monitoring, and interventions/services), we describe the organizational heterogeneity of IC within a five-hospital healthcare system. Surveys were completed by nurse managers from 12 (86%) of 14 IC settings. Six IC settings (50%) were embedded within acute care wards, four (33%) were stand-alone units, and two (17%) were embedded within an ICU. All had a nurse-to-patient ratio of 1:3, provided continuous cardiac telemetry, continuous pulse oximetry, high-flow nasal oxygen, and bedside intermittent hemodialysis. Most (> 50%) permitted arterial lines, frequent nursing assessments (every 2 hr), and noninvasive ventilation or mechanical ventilation via a tracheostomy. Vasopressors were less often permitted (< 25% of settings). Models of IC vary greatly within a single healthcare system.

Examining the Relationship Between Psychological Hardiness and Fear of Death among Nurses Working in Intensive Care and Emergency Wards

Background Psychological hardiness positively impacts the nursing profession by improving nurses' overall well-being and enhancing their ability to cope with existential challenges in patient care, such as the fear of death. Aim This study aimed to determine the relationship between psychological hardiness and fear of death in nurses working in intensive care and emergency departments. Methods This cross-sectional study was conducted through a census method involving 370 nurses employed in intensive care and emergency departments of hospitals in Birjand City in 2024. Data were collected using the Ahvaz Psychological Hardiness Questionnaire and the Collett-Lester Fear of Death Scale and analyzed using descriptive and inferential statistics. Results The mean scores for psychological hardiness and fear of death among the studied nurses were 46.81 ± 6.60 and 84.42 ± 12.09, respectively. A significant negative correlation was found between psychological hardiness and fear of death overall and across its components in nurses (p &lt; 0.001). Significant relationships were observed between psychological hardiness and variables such as gender, marital status, department of service, age, work experience, and the number of patients cared for per shift (p &lt; 0.05). Significant correlations were found between gender, department of service, the number of patients cared for at the end of life, direct participation in resuscitation efforts, and the observation of patient deaths with fear of death in nurses (p &lt; 0.05). Conclusion Enhancing psychological hardiness in nurses may help them better cope with the emotions and fears associated with their work. Educational and supportive programs to strengthen nurses' psychological hardiness are recommended.

Treating shock with norepinephrine administered in midline catheters in an intermediary care unit: a retrospective cohort study

ObjectivesA rising incidence of septic shock as well as recommendations for early vasopressor initiation has increased the number of patients eligible for norepinephrine (NE). Traditionally, NE has been administered through...

Genotypic diversity and virulence factors of Klebsiella pneumoniae in a North Indian tertiary care hospital

Klebsiella pneumoniae, a pathogen of concern worldwide can be classified as classical K. pneumoniae (cKp) and Hypervirulent K. pneumoniae (HvKp). In health care settings, genotyping and identification of hypervirulent strains enables better clinical management. The present study was conducted in a north Indian tertiary care hospital which receives both Indian and foreign patients. During the study period (September –December 2022), 29 isolates of K. pneumoniae were collected from Out Patients department (OPD), Intensive Care Unit (ICU) and wards. Genotypic profiling was based on Multi Locus Sequence Typing (MLST) and wzi type. Virulence was determined by PCR based screening of genes (RmpA, iucB, ybts, iroN) as well as phenotypic tests: string test, biofilm formation and serum neutralization assay. We identified 17 Sequence Type and 14 wzi strain. The most common Sequence Type was ST231 (6/29) followed by ST 6260 (3/29)0.15 (51.7%) isolates were carbapenem resistant (CR). Eleven isolates carried the aerobactin gene iucB and/or rmpA genes. The results of the study show the presence of diverse genotypes and virulence genes of K. pneumoniae, stressing the need for stricter surveillance. We also observed a significantly higher average length of stay in patients carrying hypervirulent or carbapenem resistant strains (p < 0.05).

Clinical features and prognostic risk factors of different sex with acute exacerbations of chronic obstructive pulmonary disease

The aim of this retrospective cohort study was to investigate the clinical characteristics and the outcomes of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients between different sex. We aimed to collect the first hospitalization patients who were diagnosed as AECOPD between 1 January 2019 to 31 December 2021 from the general ward and intensive care unit in the hole hospital, Shanghai the Fifth People’s Hospital, Fudan University. Demographic data, initial clinical symptoms, on-admission vital signs, comorbidities, laboratory tests and imaging examination, treatment, and follow-up were compared between the two groups. The patients were followed up for 30 days, 90 days, 180 days after the discharge from the hospital, all these differences were not statistically significant in hospital readmissions and mortality (P > 0.05). The multivariate analysis incorporated seven factors according to the results of the univariate regression analysis. The results showed that readmission was independently associated with increased course of disease (P = 0.032), combined with chronic pulmonary heart disease (P = 0.011), and combined with peptic ulcer (P = 0.044). Conversely, there was no correlation between sex and readmission (P = 0.304). The short-term readmission was independently associated with increased course of disease, combined with chronic pulmonary heart disease, and combined with peptic ulcer, but not with sex.

Investigating the effects of home-based rehabilitation after intensive inpatient rehabilitation on motor function, activities of daily living, and caregiver burden.

Home-based rehabilitation involves professional rehabilitation care and guidance offered by physical, occupational, and speech therapists to patients in their homes to help them recuperate in a familiar living environment. The effects on the patient's motor function and activities of daily living (ADLs), and caregiver burden for community-dwelling patients are well-documented; however, little is known about the immediate benefits in patients discharged from the hospital. Therefore, we examined the effects of continuous home-based rehabilitation immediately after discharge to patients who received intensive rehabilitation during hospitalization. We retrospectively reviewed 150 patients [mean (standard deviation, SD) = 81 (9) years] discharged from the convalescent rehabilitation and community-based integrated care wards undergoing tailored home-based rehabilitation for 6 months (provided by physical or occupational therapists: 1-2 sessions of 40-60 min each per week). The outcome measures at baseline and after 3 and 6 months were compared. The participants included in this study had orthopedic (n = 76), cerebrovascular (n = 50), neuromuscular (n = 11), cardiovascular (n = 5), respiratory (n = 3), cancer (n = 3) and other diseases (n = 2). The mean (SD) time from discharge to the start of rehabilitation was 4 (4) days. One-way analysis of variance and post-hoc comparisons showed significant improvements at 3 months from baseline in grip strength (p = 0.002), 5-repetition sit-to-stand test (p < 0.001), Standing test for Imbalance and Disequilibrium test (p = 0.025), Functional Independence Measure (p < 0.001), modified Frenchay Activities Index (p < 0.001). Additionally, a statistically significant improvement was observed in the Japanese Zarit Caregiver Burden Interview score at 6 months from baseline (p < 0.001). Home-based rehabilitation improves motor function, ADLs, and instrumental ADLs even after intensive inpatient rehabilitation and decreases the burden of the caregiver in the long term. Hence, tailored home-based rehabilitation should be continuously implemented after the completion of intensive inpatient rehabilitation.

Short- and long-term costs of sinus balloon sinuplasty and middle meatal antrostomy.

To evaluate and compare hospital related costs, postoperative costs, and the long-term costs of maxillary balloon sinuplasty (BSP) and middle meatal antrostomy (MMA) in patients with chronic rhinosinusitis. Data were collected from patient registers on 88 patients treated with BSP and 240 patients treated with MMA between 2011 and 2017. Information was also gathered on the related costs of surgery, material, postoperative ward care, and any extra patient visits that took place within one year following the operation. The costs of sick leave were estimated based on the number of sick leave days. The total costs of BSP (mean 3382 €, 95% CI 3157-3607) within one year after the operation were lower than those of MMA (mean 4546 €, 95% CI 4297-4796) (p < 0.001). However, the hospital related 24 h perioperative costs were higher in BSP (mean 1853 €, 95% CI 1781-1925) than in MMA (mean 1581 €, 95% CI 1515-1647) (p < 0.001). The number of sick leave days after BSP (mean 4 days) was half that of MMA (8 days) (p < 0.001), leading to an increase in sick leave costs after MMA. The duration of the BSP operation was significantly shorter than that of MMA. BSP of the maxillary sinus ostium appears to be less expensive than MMA when the total costs are calculated one year after the operation. This information should be considered in the preoperative visit.

Predictive Modeling of Long-Term Care Needs in Traumatic Brain Injury Patients Using Machine Learning.

Traumatic brain injury (TBI) research often focuses on mortality rates or functional recovery, yet the critical need for long-term care among patients dependent on institutional or Respiratory Care Ward (RCW) support remains underexplored. This study aims to address this gap by employing machine learning techniques to develop and validate predictive models that analyze the prognosis of this patient population. Retrospective data from electronic medical records at Chi Mei Medical Center, encompassing 2020 TBI patients admitted to the ICU between January 2016 and December 2021, were collected. A total of 44 features were included, utilizing four machine learning models and various feature combinations based on clinical significance and Spearman correlation coefficients. Predictive performance was evaluated using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve and validated with the DeLong test and SHAP (SHapley Additive exPlanations) analysis. Notably, 236 patients (11.68%) were transferred to long-term care centers. XGBoost with 27 features achieved the highest AUC (0.823), followed by Random Forest with 11 features (0.817), and LightGBM with 44 features (0.813). The DeLong test revealed no significant differences among the best predictive models under various feature combinations. SHAP analysis illustrated a similar distribution of feature importance for the top 11 features in XGBoost, with 27 features, and Random Forest with 11 features. Random Forest, with an 11-feature combination, provided clinically meaningful predictive capability, offering early insights into long-term care trends for TBI patients. This model supports proactive planning for institutional or RCW resources, addressing a critical yet often overlooked aspect of TBI care.