735 - Predictive Modeling of Inpatient Trauma Discharge Disposition

Objectives:
Acute care length of stay following major trauma are up to 30% longer than necessary due to delays in patient discharge planning. Thus, tools to predict discharge disposition early in the acute care hospitalization are needed. The objective of this study was to determine if the initial combined basic mobility and daily activity sub-scores of the Activity Measure for Post-Acute Care (AM-PAC) assessment performed following trauma exposure predicted discharge disposition.

Design:
We conducted a retrospective cohort study of adult patients (aged 18 to 90 years) admitted to Penn Presbyterian Medical Center following major trauma from 2015 to 2023, with non-missing data in the following four categories: discharge disposition, combined AM-PAC basic mobility and daily activity sub-scores (range 12-48), age, race. Data was summarized using descriptive statistics and assessed for statistically significant differences using Wilcoxon Rank Sum test and Logistic Regression modeling.

Results:
Of 4,760 patients meeting inclusion criteria (median age = 50 years; 62% black, 30% white, 8% other), 67% were discharged to home (independently or with home care) and 33% were discharge to a rehabilitation facility (ARF or SNF). The median combined AM-PAC score at the time of initial functional assessment amongst patients discharged to home was statistically significantly higher than patients discharged to a rehabilitation facility (38 vs. 25, p< 0.001). The median age for patients discharged to home was statistically significantly lower than patients discharged to a rehabilitation facility (43 vs. 62, p< 0.001). For every additional point on the combined AM-PAC score, the odds of being discharged to home relative to being discharged to a rehabilitation facility was 1.18 (95% CI 1.17 – 1.19, p< 0.001), adjusting for age and race.

Conclusions:
We found evidence that the initial combined AM-PAC basic mobility and daily activity score predicts discharge to home following major trauma, after adjusting for age and race.