266 Patient and Hospital-Level Predictors of Hospital Course for Patients With Mild Traumatic Brain Injury Treated Across a National Sample

INTRODUCTION: Mild traumatic brain injury (mTBI) is a common injury with lasting sequalae. Little is known about mTBI care pattern variations. METHODS: 92,406 mTBI patients were retrospectively identified from the ACS Trauma Quality Programs dataset. We performed a hierarchical logistic regression to investigate associations of patient-level characteristics with hospitalization. Among hospitalized patients, a hierarchical linear regression was constructed for associations with LOS using hospitals as a random effects term. Each hospital was classified as a high-LOS outlier or non-outlier and univariable comparisons on facility characteristics were conducted. Patients were propensity score matched across hospital outlier status, and a multivariable logistic regression for associations with favorable discharge disposition to home or inpatient rehabilitation was performed. RESULTS: The median age was 47 years (IQR, 29-66 years), and 69,954 (76%) patients were hospitalized. White (OR, 1.07; 95% CI, 1.005-1.03) and other non-Black (OR, 1.12; 95% CI, 1.04-1.20) races were associated with greater hospitalization odds. After excluding very low-volume centers, 66,474 hospitalized patients were treated across 657 hospitals, and 41 hospitals were designated as high-LOS outliers. These were more likely to be Level 1 trauma centers (51% vs. 30%; P<0.01) and in the highest volume quartile (49% vs. 23%; P<0.001). After matching, patients treated at high-LOS hospitals were independently less likely to experience favorable discharge (OR, 0.74; 95% CI, 0.67 to 0.82). CONCLUSIONS: Black mTBI patients were less likely to be hospitalized. There is significant inter-hospital variation in LOS for hospitalized mTBI patients, with Level 1 trauma centers and higher-volume centers more likely to be high-LOS outliers. Despite longer LOS, patients treated at outlier hospitals experienced less favorable discharge. These findings contextualize disparities and resource utilization in mTBI care.