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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).
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.
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