AI Insight
This study tracked 222 severe acute brain injury patients after hospitalization and found that two-thirds survived to discharge, primarily to nursing facilities or rehabilitation centers. Among 109 patients followed for one year, there were high rates of healthcare utilization including 89 rehospitalizations and 104 emergency department visits, with 28 deaths occurring. Patients from the most disadvantaged neighborhoods had over three times higher odds of rehospitalization or emergency department use within 30 days, and outpatient care rarely included discussions about prognosis or goals-of-care despite these patients' complex needs.
Why it matters
The findings reveal significant gaps in post-discharge care coordination and communication for severe brain injury survivors, particularly affecting socioeconomically disadvantaged patients. This suggests a need for structured long-term care planning and better integration of palliative care discussions to reduce preventable hospitalizations and ensure care aligns with patient goals.
⚠️ Preprint – Noch nicht peer-reviewed
Dieser Artikel wurde noch nicht von unabhängigen Experten begutachtet. Die Ergebnisse sind vorläufig und sollten mit Vorsicht interpretiert werden.
INTRODUCTION Severe acute brain injury (stroke, traumatic brain injury or hypoxic-ischemic encephalopathy; SABI) is increasingly recognized as a chronic condition with care and communication needs beyond the initial hospitalization. This study aimed to characterize post-acute care patterns among SABI survivors, focusing on healthcare utilization and outpatient communication. METHODS Data were collected from a prospective cohort of hospitalized SABI patients using surveys, chart reviews, and the ED Information Exchange database. Socioeconomic disadvantage was assessed using the Area Deprivation Index (ADI), and qualitative analysis of outpatient notes examined conversations around palliative care needs and goals-of-care. RESULTS Two-thirds of patients (140/222) survived until discharge, primarily to nursing facilities (39%) or inpatient rehabilitation (38%). Among 109 with one-year follow-up, there were 89 hospitalizations, 104 ED visits, and 28 deaths. Patients from the most disadvantaged neighborhoods had significantly higher odds of rehospitalization or ED use within 30 days (OR 3.37, p=0.036). ADI was not linked to one-year utilization. seen outpatient by primary care (40%), neurology/neurosurgery (57%), and palliative care (1%), but conversations rarely revisited prognosis or goals-of-care. CONCLUSIONS Our findings highlight the need for improved long-term care planning and communication, particularly for socioeconomically disadvantaged survivors of SABI.
Source: Surviving Severe Acute Brain injury: Care trajectories and missed opportunities