E. Winford1, L. Tennakoon3, L. Knowlton3, M. Martin2, K. Staudenmayer3 1Meharry Medical College,School Of Medicine,Nashville, TN, USA 2Stanford University,Department Of Medicine,Palo Alto, CA, USA 3Stanford University,Department Of Surgery,Palo Alto, CA, USA
Introduction: Cerebrovascular accident (CVA) and traumatic brain injury (TBI) are leading causes of disability and are increasingly common in older adults. While both result in some form of brain injury, it is unknown whether the impact they have on outcomes is the same. We hypothesized that short-term outcomes and 6-month healthcare utilization would be worse for stroke.
Methods: The 2014 National Readmissions Database (NRD), a longitudinal, all-payer database was used. Patients were included in the study if they were ≥65 years and were admitted with a primary diagnosis of either CVA or TBI during the first half of the year. Patients were excluded if their primary diagnosis was “transient ischemic attack” for CVA; for TBI, patients with evidence of multiple injuries were excluded (AIS≥2 in any other body region). The primary outcome was mortality during index hospitalization. Secondary outcomes included rates of tracheostomy and gastrostomy, and 6-month inpatient hospitalization days and costs. Unadjusted and adjusted analyses were performed. Weighted numbers are reported.
Results: 175,415 patients met inclusion and exclusion criteria. Mortality during the index hospitalization was lower for CVA (8.8% vs 10.3% for CVA and TBI, respectively, p<0.001). After controlling for known confounders, CVA was associated with lower inpatient mortality (OR 0.92, 95% CI 0.86-0.98). Rates of gastrostomy and tracheostomy differed for both groups. For CVA vs. TBI, 4.9% vs. 2.8%, (p<0.001) of patients had a gastrostomy, whereas 0.9% vs. 1.3% had a tracheostomy (P=0.0002). This held true in adjusted analysis, where CVA was associated with a higher likelihood of gastrostomy and lower likelihood of tracheostomy vs. TBI (gastrostomy OR 1.95, 95% CI 1.75-2.17; tracheostomy OR 0.81, 95% CI 0.68-0.95). Despite these differences, 6-month inpatient costs and hospital days were similar. For CVA vs. TBI, 6-month costs were $15,507.77 vs. $15,945.47 (p=0.16) and hospital days were 7.0 days vs. 6.5 days (p<0.001). There was no difference when controlling for known confounders.
Conclusion: Brain injury is the final common pathway of CVA and TBI. Following CVA and TBI, healthcare costs and LOS are the same. Interestingly, rates of tracheostomy and gastrostomy are different for the two populations. This may be due to different needs, but also might be due to differences in patient management by different types of physicians. This suggests an opportunity for physicians caring for CVA and TBI patients to further explore and improve care by comparing management of patients who sustain brain injury by any mechanism.