reports

Determinants of delayed discharge from acute care among patients with hypoxic-ischemic brain injury

Arch Phys Med Rehabil 96:e15.

Toronto Rehabilitation Institute, Toronto, ON, Canada

Objective(s): To describe key demographic and acute care characteristics  of patients admitted with a hypoxic-ischemic brain injury (HIBi) diagnosis  and investigate determinants of delayed discharge among survivors.

Design: Prospective cohort.

Setting: Ontario, Canada.

Participants: Patients aged 20 years and older with a HIBi diagnosis in  acute care between 2002/03 and 2011/12 identified by International  Classification of Diseases Version 10 codes (N = 3,228).

Interventions: NIA.

Main Outcome Measure(s): Days spent in an alternate level of care  (ALC) bed during the acute care episode as a marker of  delayed discharge.

Results: Approximately 21 % of HIBi patients survived acute care  (n=675). HIBi survivors tended to be younger, to live in an area If lower  socioeconomic status by income, to have less comorbidi ty burden and have  a higher likelihood of an accompanying psychological comorbidity than  those who died. Of the survivors, 41 .6% had at least one ALC day and a  median of 19 (!QR: 8-40) ALC days among those who had any. Of those  likely to have ALC, 20-34 year olds had higher rates of ALC days relative  to length of stay (LOS) compared to those 65-79 (RR= 1.44; 95%  CI= 1.05-1.97). Time spent in special care (e.g., intensive care,  coronary care) and later year of acute care episode was inversely associated  with rates of ALC days. Waiting for a palliative, long-term care or  inpatient rehabilitation bad was the strongest predictor of having any  ALC days.

Conclusions: HIBi survivors have high rates of delayed discharge. That  they are more likely to have a psychiatric condition and be of younger age  suggests that inefficiencies in the delivery of appropriate care for this  unique patient population will not be remedied if interventions are based  on other models of acquired brain injury.