Objective

To identify determinants of discharge disposition from acute care among survivors of hypoxic-ischemic brain injury (HIBI), stratified by sex.

Design

Population-based retrospective cohort study using provincial data in Ontario, Canada. The determinants were grouped into predisposing, need, and enabling factors using the Anderson Behavioral Model.

Setting

Acute care.

Participants

Survivors of HIBI aged ≥20 years at the time of hospitalization and discharged alive from acute care between April 1, 2002, and March 31, 2017. There were 7492 patients with HIBI, of whom 28% (N=2077) survived their acute care episode.

Interventions

Not applicable.

Main Outcome Measures

Discharge disposition from acute care, categorized as complex continuing care (CCC), long-term care (LTC), inpatient rehabilitation (IR), home with support, home without support, and transferred to another acute care.

Results

The discharge dispositions for the 2077 survivors were IR 23.4% (n=487), CCC 19.5% (n=404), LTC 6.2% (n=128), home without support 31.2% (n=647), home with support 15.1% (n=314), and other 4.6%. Multinomial multivariable logistic regression analysis using home without support as the reference category revealed that female patients were significantly more likely than male patients to be discharged to LTC/CCC. Those who were older, were frail, and had longer stay in acute care or special care unit (SCU) were more likely to be discharged to LTC/CCC. The only significant determinant for IR was longer stay in acute care. Survivors with cardiac-related injury were less likely to be discharged to LTC/CCC. Income was a significant factor for male patients but not for female patients in the sex-stratified analysis. The following variables were investigated but were not significant determinants in this study: need factors (comorbidity score, prior psychiatric disorders, health care utilization) and enabling factors (income quintile, rural area of residence).

Conclusions

Predisposing (age, sex) and need factors (frailty, acute care days, SCU days, type of injury) were significant determinants of discharge disposition from acute care after HIBI. In spite of a system with universal coverage, sex differences were found, with more female patients being discharged to CCC/LTC rather than IR, controlling for age and other confounders. These findings should be considered in appropriate discharge planning from acute care for survivors of HIBI.

中文翻译：

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缺氧缺血性脑损伤幸存者急性护理出院处置的决定因素：来自基于大量人群的队列数据集的结果

客观的

确定按性别分层的缺氧缺血性脑损伤 (HIBI) 幸存者急性护理出院处置的决定因素。

设计

使用加拿大安大略省数据的基于人群的回顾性队列研究。使用安德森行为模型将决定因素分为易感因素、需要因素和促成因素。

环境

急性护理。

参与者

2002 年 4 月 1 日至 2017 年 3 月 31 日期间住院时年龄≥20 岁且从急诊治疗中存活出院的 HIBI 幸存者。 共 7492 例 HIBI 患者，其中 28%（N=2077）在急诊治疗中存活插曲。

干预

不适用。

主要观察指标

急性护理的出院处置，分类为复杂的持续护理 (CCC)、长期护理 (LTC)、住院康复 (IR)、有支持的家庭、无支持的家庭，并转移到另一个急性护理。

结果

2077 名幸存者的出院情况为 IR 23.4% (n=487)，CCC 19.5% (n=404)，LTC 6.2% (n=128)，家中无人支持 31.2% (n=647)，家中有支持 15.1 % (n=314) 和其他 4.6%。以无家庭支持为参考类别的多项多变量逻辑回归分析显示，女性患者出院到 LTC/CCC 的可能性明显高于男性患者。那些年龄较大、体弱且在急症护理或特殊护理病房 (SCU) 停留时间较长的患者更有可能出院至 LTC/CCC。IR 的唯一重要决定因素是更长时间的急性护理。有心脏相关损伤的幸存者出院到 LTC/CCC 的可能性较小。在性别分层分析中，收入是男性患者的一个重要因素，但不是女性患者的重要因素。

结论

易感因素（年龄、性别）和需要因素（虚弱、急性护理天数、SCU 天数、损伤类型）是 HIBI 后急性护理出院处置的重要决定因素。尽管系统具有普遍覆盖，但发现了性别差异，在控制年龄和其他混杂因素后，更多的女性患者出院到 CCC/LTC 而不是 IR。在对 HIBI 幸存者进行急性护理的适当出院计划中应考虑这些发现。