{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:15:57Z","timestamp":1781190957721,"version":"3.54.1"},"posted":{"date-parts":[[2026,6,9]]},"group-title":"Neurology","reference-count":22,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000065","name":"National Institute of Neurological Disorders and Stroke","doi-asserted-by":"crossref","award":["K23NS099421"],"award-info":[{"award-number":["K23NS099421"]}],"id":[{"id":"10.13039\/100000065","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,6,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>Severe acute brain injury (stroke, traumatic brain injury or hypoxic-ischemic encephalopathy; SABI) is increasingly recognized as a chronic condition with care and communication needs beyond the initial hospitalization. This study aimed to characterize post-acute care patterns among SABI survivors, focusing on healthcare utilization and outpatient communication.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Data were collected from a prospective cohort of hospitalized SABI patients using surveys, chart reviews, and the ED Information Exchange database. Socioeconomic disadvantage was assessed using the Area Deprivation Index (ADI), and qualitative analysis of outpatient notes examined conversations around palliative care needs and goals-of-care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Two-thirds of patients (140\/222) survived until discharge, primarily to nursing facilities (39%) or inpatient rehabilitation (38%). Among 109 with one-year follow-up, there were 89 hospitalizations, 104 ED visits, and 28 deaths. Patients from the most disadvantaged neighborhoods had significantly higher odds of rehospitalization or ED use within 30 days (OR 3.37, p=0.036). ADI was not linked to one-year utilization. Two-thirds of survivors (68%) were seen outpatient by primary care (40%), neurology\/neurosurgery (57%), and palliative care (1%), but conversations rarely revisited prognosis or goals-of-care.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Our findings highlight the need for improved long-term care planning and communication, particularly for socioeconomically disadvantaged survivors of SABI.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.06.01.26354480","type":"posted-content","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T22:35:12Z","timestamp":1781044512000},"source":"Crossref","is-referenced-by-count":0,"title":["Surviving Severe Acute Brain injury: Care trajectories and missed opportunities"],"prefix":"10.64898","author":[{"given":"Adam L.","family":"Bunker","sequence":"first","affiliation":[{"name":"University of Washington School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth A.","family":"Engelberg","sequence":"additional","affiliation":[{"name":"Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle"},{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert G.","family":"Holloway","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1564-9999","authenticated-orcid":false,"given":"Claire J.","family":"Creutzfeldt","sequence":"additional","affiliation":[{"name":"Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, Seattle"},{"name":"Department of Neurology, University of Washington, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"54368","reference":[{"key":"2026061107551410000_2026.06.01.26354480v1.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1908153"},{"key":"2026061107551410000_2026.06.01.26354480v1.2","doi-asserted-by":"crossref","first-page":"710783","DOI":"10.3389\/fneur.2021.710783","article-title":"Goal-Concordant Care After Severe Acute Brain Injury","volume":"12","year":"2021","journal-title":"Front Neurol"},{"issue":"2","key":"2026061107551410000_2026.06.01.26354480v1.3","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1161\/STROKEAHA.119.026133","article-title":"Factors Associated With 90-Day Readmission After Stroke or Transient Ischemic Attack: Linked Data From the Australian Stroke Clinical Registry","volume":"51","year":"2020","journal-title":"Stroke"},{"issue":"8","key":"2026061107551410000_2026.06.01.26354480v1.4","doi-asserted-by":"crossref","first-page":"e0289640","DOI":"10.1371\/journal.pone.0289640","article-title":"Rates and reasons for hospital readmission after acute ischemic stroke in a US population-based cohort","volume":"18","year":"2023","journal-title":"PLoS One"},{"key":"2026061107551410000_2026.06.01.26354480v1.5","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.jss.2019.06.071","article-title":"Readmissions After Acute Hospitalization for Traumatic Brain Injury","volume":"244","year":"2019","journal-title":"J Surg Res"},{"key":"2026061107551410000_2026.06.01.26354480v1.6","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18308"},{"issue":"17","key":"2026061107551410000_2026.06.01.26354480v1.7","first-page":"e1776","article-title":"Association Between Neighborhood Socioeconomic Status and 30-Day Mortality and Readmission for Patients With Common Neurologic Conditions","volume":"100","year":"2023","journal-title":"Neurology"},{"issue":"4","key":"2026061107551410000_2026.06.01.26354480v1.8","doi-asserted-by":"crossref","first-page":"e239949","DOI":"10.1001\/jamanetworkopen.2023.9949","article-title":"Identification of Palliative Care Needs and Mental Health Outcomes Among Family Members of Patients With Severe Acute Brain Injury","volume":"6","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026061107551410000_2026.06.01.26354480v1.9","unstructured":"Collective Medical. ED Utilization. 2023 June 9, 2023]; Available from: http:\/\/collectivemedical.com\/impact\/ed-utilization\/."},{"issue":"1","key":"2026061107551410000_2026.06.01.26354480v1.10","doi-asserted-by":"crossref","first-page":"e000550","DOI":"10.1136\/tsaco-2020-000550","article-title":"Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors","volume":"6","year":"2021","journal-title":"Trauma Surg Acute Care Open"},{"key":"2026061107551410000_2026.06.01.26354480v1.11","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1802313"},{"key":"2026061107551410000_2026.06.01.26354480v1.12","unstructured":"University of Wisconsin School of Medicine and Public Health. 2019 Area Deprivation Index v. 3.0. 2022 March 20, 2022]; Available from: https:\/\/www.neighborhoodatlas.medicine.wisc.edu\/."},{"key":"2026061107551410000_2026.06.01.26354480v1.13","unstructured":"Centers for Medicare and Medicaid Services. 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Differences in the Occurrence of Goals-of-Care Discussions as Reported by Patients, Clinicians, and in the Electronic Health Record","volume":"57","year":"2019","journal-title":"J Pain Symptom Manage"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.64898\/2026.06.01.26354480","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:55:29Z","timestamp":1781189729000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.64898\/2026.06.01.26354480"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,9]]},"references-count":22,"URL":"https:\/\/doi.org\/10.64898\/2026.06.01.26354480","relation":{},"subject":[],"published":{"date-parts":[[2026,6,9]]},"subtype":"preprint"}}