Acquired Brain Injury by Local Health Integration Network in Ontario
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1 Acquired Brain Injury by Local Health Integration Network in Research Team: Angela Colantonio, Principal Investigator Senior Research Scientist, Toronto Rehabilitation Institute UHN Professor of Occupational Sciences and Occupational Therapy, University of Toronto , Lab: ; Fax: Vincy Chan, Research Analyst Daria Parsons, Consultant Brandon Zagorski, Statistical Consultant Acknowledgements: This study was funded by the Neurotrauma Foundation. We wish to acknowledge support from the Ministry of Health and Long Term Care, the Toronto Rehabilitation Institute UHN, and the University of Toronto.
2 LHIN LIST OF TABLES TABLE 1: CHARACTERISTICS OF TBI PATIENTS DISCHARGED TO LONG TERM CARE FROM ACUTE CARE, 2003/ / TABLE 2. CHARACTERISTICS OF NTBI PATIENTS DISCHARGED TO LONG TERM CARE FROM ACUTE CARE, 2003/ / TABLE 3. CHARACTERISTICS OF TBI PATIENTS DISCHARGED TO INPATIENT REHABILITATION FROM ACUTE CARE, 2003/ / TABLE 4. CHARACTERISTICS OF NTBI PATIENTS DISCHARGED TO INPATIENT REHABILITATION FROM ACUTE CARE, 2003/ / TABLE 5. CHARACTERISTICS OF TBI PATIENTS LIVING IN RESIDENTIAL CARE AT DISCHARGE FROM INPATIENT REHABILITATION, 2003/ / TABLE 6. CHARACTERISTICS OF NTBI PATIENTS LIVING IN RESIDENTIAL CARE AT DISCHARGE FROM INPATIENT REHABILITATION, 2003/ / TABLE 7. CHARACTERISTICS OF TBI PATIENTS WITH 15+ DAYS IN ALC, 2003/ / TABLE 8. CHARACTERISTICS OF NTBI PATIENTS WITH 15+ DAYS IN ALC, 2003/ / TABLE 9. CHARACTERISTICS OF TBI PATIENTS DISCHARGED WITH EXTENDED LENGTH OF STAY IN ACUTE CARE, 2003/ / TABLE 10. CHARACTERISTICS OF NTBI PATIENTS DISCHARGED WITH EXTENDED LENGTH OF STAY IN ACUTE CARE, 2003/ /10.21 TABLE 11. CHARACTERISTICS OF TBI PATIENTS READMITTED TO ACUTE CARE WITHIN ONE MONTH OF DISCHARGE, 2003/ /09.23 TABLE 12. CHARACTERISTICS OF NTBI PATIENTS READMITTED TO ACUTE CARE WITHIN ONE MONTH OF DISCHARGE, 2003/ / TABLE 13. ICD-10 DEFINITION OF TBI...27 TABLE 14. ICD-10 DEFINITION OF NTBI
3 LHIN Methods Acquired brain injury (ABI), which includes brain injury from traumatic (e.g., falls, motor vehicle collisions) and non-traumatic (e.g., anoxia, brain tumours) causes, is a leading cause of death and disability in Canada (please see Table 13 and Table 14 for a list of ABI definitions used in this report). ABI is more common than breast cancer, HIV/AIDS, spinal cord injury, and multiple sclerosis combined. The ABI Dataset Project, funded by the Neurotrauma Foundation, utilized existing administrative data to answer important research questions about ABI in that resulted from a recent publication of ABI by Local Health Integration Network (LHIN) in (please see ABI Program in Action ABI Data). This analysis included fiscal years 2003/04 to 2009/10. LHIN-specific analyses based on inpatient acute care data were obtained from the Discharge Abstract Database (DAD) and inpatient rehabilitation data were obtained from the National Rehabilitation Reporting System (NRS). Six questions were addressed in this report: 1. Who is discharged to long term care from acute care? 2. Who is discharged to inpatient rehabilitation from acute care? 3. Who is living in residential care at discharge from inpatient rehabilitation? 4. What are the characteristics of ABI patients with 15+ days in alternate level of care? 5. What are the characteristics of ABI patients with extended length of stay in acute care? 6. Who is readmitted to acute care within 30 days of discharge? Definitions of terms used in the report: - Alternate Level of Care (ALC): An ALC patient is one who has completed the acute care phase of his or her treatment but remains in the acute care bed (CIHI 2009) - Charlson Comorbidity Index: The Charlson Comorbidity Index estimates the risk of death from comorbid diseases and is calculated as an indicator of the need of patients with ABI - Special Care Days: The cumulative number of days spent in all intensive care units 2
4 LHIN Who is Discharged to Long Term Care from Acute Care? Table 1. of TBI Patients Discharged to Long Term Care from Acute Care, 2003/ /10 Age Sex Overall , < < NR Female Male Fiscal Year of Discharge 2003/ / / / / / / Length of Stay in Acute Care Charlson Comorbidity Index Score 0 1 (low) , (high) Psychiatric Comorbidity Yes No Number of ALC Days None < NR
5 LHIN Number of Special Care Days None , Motor Vehicle Collision Yes No , Number of Previous ABI Admissions , Note: NR = not reportable due to small cell size 4
6 LHIN Table 2. of ntbi Patients Discharged to Long Term Care from Acute Care, 2003/ /10 Age Sex Overall , < < NR , , Female , Male , Fiscal Year of Discharge 2003/ / / / / / / Length of Stay in Acute Care , , Charlson Comorbidity Index Score 0 1 (low) , , (high) Psychiatric Comorbidity Yes , No , Number of ALC Days None , , Number of Special Care Days None ,
7 LHIN Number of Previous ABI Admissions , Note: NR = not reportable due to small cell size 6
8 LHIN Who is Discharged to Inpatient Rehabilitation from Acute Care? Table 3. of TBI Patients Discharged to Inpatient Rehabilitation from Acute Care, 2003/ /10 Age Sex Overall , <19 < , NR Female , Male , Fiscal Year of Discharge 2003/ / / / / / / Length of Stay in Acute Care 1 2 < NR , Charlson Comorbidity Index Score 0 1 (low) , (high) Psychiatric Comorbidity Yes No , Number of ALC Days None ,
9 LHIN Number of Special Care Days None , Motor Vehicle Collision Yes , No , Number of Previous ABI Admissions , Note: NR = not reportable due to small cell size 8
10 LHIN Table 4. of ntbi Patients Discharged to Inpatient Rehabilitation from Acute Care, 2003/ /10 Age Sex Overall , <19 < , , , NR Female , Male , Fiscal Year of Discharge 2003/ / / / / / / Length of Stay in Acute Care 1 2 < NR , , Charlson Comorbidity Index Score 0 1 (low) , , (high) Psychiatric Comorbidity Yes No , Number of ALC Days None , Number of Special Care Days None ,
11 LHIN Number of Previous ABI Admissions , , Note: NR = not reportable due to small cell size 10
12 LHIN Who Lives in Residential Care* at Discharge from Inpatient Rehabilitation? * This analysis combined data for ABI patients living in a residential care facility and those living in assisted living settings at discharge from inpatient rehabilitation. Table 5. of TBI Patients Living in Residential Care at Discharge from Inpatient Rehabilitation, 2003/ /10 Age Sex Overall Female Male Fiscal Year of Discharge 2003/ / /06 NR /07 < / / / Length of Stay in Acute Care 1 2 < < < Charlson Comorbidity Index Score 0 1 (low) NR (high) < Psychiatric Comorbidity Yes No Number of ALC Days None <
13 LHIN 3 5 < Number of Special Care Days None Motor Vehicle Collision Yes No Number of Previous ABI Admissions NR < Note: NR = not reportable due to small cell size 12
14 LHIN Table 6. of ntbi Patients Living in Residential Care at Discharge from Inpatient Rehabilitation, 2003/ /10 Age Sex Overall Female Male Fiscal Year of Discharge 2003/ / / / / / / Length of Stay in Acute Care 1 2 < < Charlson Comorbidity Index Score 0 1 (low) (high) Psychiatric Comorbidity Yes No Number of ALC Days None < NR Number of Special Care Days None
15 LHIN Number of Previous ABI Admissions NR < Note: NR = not reportable due to small cell size 14
16 LHIN What are the of ABI Patients with 15+ Days in ALC*? * This analysis focused on the characteristics of ABI patients with 15+ days in ALC as a result of feedback received from LHINs on the recently published ABI reports. Table 7. of TBI Patients with 15+ Days in ALC, 2003/ /10 Age Sex Overall , <19 < NR Female Male , Fiscal Year of Discharge 2003/ / / / / / / Charlson Comorbidity Index Score 0 1 (low) , (high) Psychiatric Comorbidity Yes No , Number of Special Care Days None , Motor Vehicle Collision Yes
17 LHIN No , Number of Previous ABI Admissions , Discharge Destination 1 Death Home Inpatient Rehabilitation Long Term Care Transferred Note: NR = not reportable due to small cell size 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 16
18 LHIN Table 8. of ntbi Patients with 15+ Days in ALC, 2003/ /10 Age Sex Overall , < , , Female , Male , Fiscal Year of Discharge 2003/ / / / / / / Charlson Comorbidity Index Score 0 1 (low) , , (high) , Psychiatric Comorbidity Yes , No , Number of Special Care Days None , Number of Previous ABI Admissions , , Discharge Destination 1 Death , Home Inpatient Rehabilitation Long Term Care
19 LHIN Transferred , Note: 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 18
20 LHIN Who is Discharged with Extended Length of Stay* in Acute Care? * Extended length of stay (LOS) is defined as LOS in the 75 th percentile and higher. Table 9. of TBI Patients Discharged with Extended Length of Stay in Acute Care, 2003/ /10 Age Sex Overall 1, , < , , , , Female , Male , Fiscal Year of Discharge 2003/ , / , / , / , / , / , / , Charlson Comorbidity Index Score 0 1 (low) , , (high) Psychiatric Comorbidity Yes , No , Number of ALC Days None , , , Number of Special Care Days None ,
21 LHIN , , , Motor Vehicle Collision Yes , No , Number of Previous ABI Admissions , , Discharge Destination 1 Death Home , Inpatient Rehabilitation , Long Term Care Transferred , Note: 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 20
22 LHIN Table 10. of ntbi Patients Discharged with Extended Length of Stay in Acute Care, 2003/ /10 Age Sex Overall 3, , < , , , , , , Female 1, , Male 1, , Fiscal Year of Discharge 2003/ , / , / , / , / , / , / , Charlson Comorbidity Index Score 0 1 (low) 1, , , (high) 1, , Psychiatric Comorbidity Yes , No 2, , Number of ALC Days None 1, , , , , Number of Special Care Days None 1, , , , , , Number of Previous ABI Admissions 0 1, , , ,
23 LHIN Discharge Destination 1 Death , Home 1, , Inpatient Rehabilitation , Long Term Care , Transferred , Note: 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 22
24 LHIN Who is Readmitted to Acute Care within One Month of Discharge? Table 11. of TBI Patients Readmitted to Acute Care within One Month of Discharge, 2003/ /09 Age Sex (N = 2,702) (N = 30,579) Overall , < Female Male Fiscal Year of Discharge 2003/ / / / / / Length of Stay in Acute Care Charlson Comorbidity Index Score 0 1 (low) , NR (high) < Psychiatric Comorbidity Yes No Number of ALC Days None , < <
25 LHIN Number of Special Care Days (N = 2,702) (N = 30,579) None < < Motor Vehicle Collision Yes No , Number of Previous ABI Admissions Discharge Destination 1 Home Inpatient Rehabilitation Long Term Care NR Transferred 2 < Note: NR = not reportable due to small cell size 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 24
26 LHIN Table 12. of ntbi Patients Readmitted to Acute Care within One Month of Discharge, 2003/ /09 Age Sex (N = 8,750) (N = 97,700) Overall , < , , , , , Female , Male , Fiscal Year of Discharge 2003/ , / , / , / , / , / , Length of Stay in Acute Care , , , , Charlson Comorbidity Index Score 0 1 (low) , , (high) , Psychiatric Comorbidity Yes No , Number of ALC Days None , Number of Special Care Days None ,
27 LHIN Number of Previous ABI Admissions (N = 8,750) (N = 97,700) , , Discharge Destination 1 Home , Inpatient Rehabilitation Long Term Care Transferred Note: 1 Missing values were excluded and thus, column percentages may not add up to 100% 2 Transferred includes transferred to another facility providing inpatient hospital care and to other 26
28 LHIN ICD-10 Definitions of ABI Table 13. ICD-10 Definition of TBI Diagnosis 1. Fracture and crushing of the skull and facial bones 2. Intracranial injury, excluding those with skull fracture 3. Late effects of injuries The sequelae include conditions specified as such or as late effects, or those present one year or more after onset of the causal condition. ICD-10 Code and Description S02.0 Fracture of vault of skull S02.1 Fracture of base of skull S02.3 Fracture of the orbital floor S02.7 Multiple fractures involving skull and facial bones S02.8 Fractures of other skull and facial bones S02.9 Fractures of skull and facial bones, part unspecified S07.1 Crushing injury of skull S06.0 Concussion S06.1 Traumatic cerebral oedema S06.2 Diffuse brain injury S06.3 Focal brain injury S06.4 Epidural hemorrhage S06.5 Traumatic subdural hemorrhage S06.6 Traumatic subarachnoid hemorrhage S06.7 Intracranial injury with prolonged coma S06.8 Other intracranial injuries S06.9 Intracranial injury, unspecified F07.2 Post concussion syndrome T90.2 Sequelae of fracture of skull and facial bones T90.5 Sequelae of intracranial injury 27
29 LHIN Table 14. ICD-10 Definition of ntbi Diagnosis 1. Toxic effect of substances, chiefly non-medical as to source ICD-10 Code and Description T40.5 Poisoning: cocaine T42.6 Poisoning by other antiepileptic and sedative-hypnotic drugs, Methaqualone, Valproic acid T51 Toxic effect of alcohol T56 Toxic effect of metals T57.0 Toxic effect of arsenic and its compounds T57.2 Toxic effect of manganese and its compounds T57.3 Toxic effect of hydrogen cyanide T58 Toxic effect of carbon monoxide T64 Toxic effect of aflatoxin and other mycotoxin food contaminants T65.0 Toxic effect of cyanides 2. Anoxia G93.1 Anoxic brain damage (includes all causes of anoxia except those occurring following abortions, ectopic pregnancy, labour and delivery and newborn) T71 Asphyxiation, suffocation (by strangulation) T75.1 Drowning and nonfatal submersion R09.0 Asphyxia 3. Vascular insults (not captured in stroke analyses) I62.0 Subdural hemorrhage I62.9 Unspecified intracranial hemorrhage 4. Brain tumours C70 Malignant neoplasm of brain C71 Malignant neoplasm of brain C79.3 Secondary malignant neoplasm of brain and cerebral meninges C79.4 Secondary malignant neoplasm of other and unspecified part of nervous system D32.0 Benign neoplasm of cerebral meninges D33.0 Benign neoplasm of brain, supratentorial D33.1 Benign neoplasm of brain, infratentorial D33.2 Benign neoplasm of brain, unspecified D33.3 Benign neoplasm of cranial nerves D42.0 Neoplasm of uncertain or unknown behaviour of cerebral meninges D43 Neoplasm of uncertain or unknown behaviour of brain and central nervous system D43.2 Neoplasm of brain, unspecified G06.0 Intracranial abscess and granuloma G06.1 Intraspinal abscess and granuloma G06.2 Extradural and subdural abscess, unspecified G07 Intracranial and intraspinal abscess and granuloma in disease classified elsewhere G93.0 Cerebral cysts 28
30 LHIN Diagnosis ICD-10 Code and Description 5. Encephalitis A81.1 Subacute, sclerosing encephalitis A83.0 Japanese encephalitis A83.2 Eastern equine encephalitis A86.0 Unspecified viral encephalitis B00.4 Herpes viral meningoencephalitis B01.1 Varicella encephalitis B02.0 Zoster encephalitis B05.0 Postmeasles encephalitis B94.1 Sequelae of viral encephalitis G04.0 Acute disseminated encephalitis G04.2 Bacterial meningoencephalitis and meningomyelitis, not elsewhere classified G04.8 Other encephalitis, myelitis and encephalomyelitis G04.9 Encephalitis, myelitis, and encephalomyelitis, unspecified G05 Encephalitis, myelitis, and encephalomyelitis in diseases classified elsewhere G09 Sequelae of inflammatory diseases of central nervous system 6. Metabolic encephalopathies E10.0 (Type I) E11.0 (Type II) E13.0 Other specified diabetes mellitus with coma E14.0 Unspecified diabetes mellitus with coma E15 Nondiabetic hypoglycaemic coma G92 Toxic encephalopathy G93.4 Encephalopathy, unspecified 7. Meningitis A87 Viral meningitis B01.0 Varicella meningitis B37.5 Candidal meningitis G00 Bacterial meningitis, not elsewhere classified G01 Meningitis in bacterial diseases classified elsewhere G02 Meningitis in other infectious and parasitic diseases classified elsewhere G03 Meningitis due to other and unspecified causes 8. Other brain disorders and infections G91.0 Communicating hydrocephalus G91.1 Obstructive hydrocephalus G91.2 Normal-pressure hydrocephalus G93.2 Benign intracranial hypertension G93.5 Compression of brain G93.6 Cerebral oedema G93.8 Other specified disorders of the brain (including post-radiation encephalopathy) G93.9 Disorder of the brain, unspecified G99.8 Other specified disorders of nervous system in diseases classified elsewhere R29.1 Meningismus 29
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