Correlating Various Clinical Outcomes and Associated Dispositions in Patients with Severe Traumatic Brain Injury (TBI)

Background: TBI is a major cause of death and disability worldwide. Patient disposition following TBI has been shown to interact with factors such as age, sex, and injury severity to impact clinical outcomes. Discharge home is associated with better functional outcomes and lower mortality, while discharge to rehabilitation or long-term care facilities is linked to greater injury severity, older age, and higher comorbidity burden. Methods: This is a retrospective study (2020-2023) of dispositions in patients with severe TBI with AIS (head) ≥3. We observed the relationship between patient disposition and a range of clinical variables, using both parametric (ANOVA) and non-parametric (Kruskal-Wallis, Wilcoxon, Van der Waerden, Savage, Kolmogorov-Smirnov, and Cramer-von Mises) statistical tests. Results: 824 patients (617 male) admitted for severe TBI were included in our analysis. Most patients were discharged home (52.8%), followed by died (12.4%), inpatient rehab (5.1%), and home with services (5.6%). Significant associations were found between disposition and gender (p = 0.0174), as well as between disposition and injury type (p = 0.0186). Disposition was also significantly associated with all major clinical variables (EDLOS, HLOS, ICULOS, vent, GCS, AIS, and ISS), with p-values < 0.0001 for ANOVA and non-parametric tests. Alcohol levels showed a significant association with disposition (p < 0.001) as well. Conclusion: Our study supports existing evidence that discharge disposition following severe TBI is influenced by several factors, such as injury severity, age, demographic factors, mechanism of injury, alcohol use, and hospital characteristics, and is closely linked to both short- and long-term clinical outcomes.