The truth about trauma readmissions

Olubode A Olufajo; Zara Cooper; Brian K Yorkgitis; Peter A Najjar; David Metcalfe; Joaquim M Havens; Reza Askari; Gabriel A Brat; Adil H Haider; Ali Salim

doi:10.1016/j.amjsurg.2015.09.018

The truth about trauma readmissions

Am J Surg. 2016 Apr;211(4):649-55. doi: 10.1016/j.amjsurg.2015.09.018. Epub 2015 Dec 31.

Authors

Affiliations

¹ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA. Electronic address: oao777@mail.harvard.edu.
² Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA.
³ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
⁴ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA.

PMID: 26822268
DOI: 10.1016/j.amjsurg.2015.09.018

Abstract

Background: There is a paucity of data on the causes and associated patient factors for unplanned readmissions among trauma patients.

Methods: We examined patients admitted for traumatic injuries between 2007 and 2011 in the California State Inpatient Database. Using chi-square tests and multivariate logistic regression models, we determined rates, reasons, locations, and patient factors associated with 30-day readmissions.

Results: Among 252,752 trauma discharges, the overall readmission rate was 7.56%, with 36% of readmissions occurring at a hospital different from the hospital of initial admission. Predictors of readmissions included being discharged against medical advice (odds ratio [OR]: 2.56 [2.35 to 2.76]); Charlson scores ≥2 (OR: 2.00 [1.91 to 2.10]); and age ≥45 years (OR: 1.29 [1.25 to 1.33]). Major reasons for readmissions were musculoskeletal complaints (22.29%), psychiatric conditions (9.40%), and surgical infections (6.69%).

Conclusions: Health and social vulnerabilities influence readmission among trauma patients, with many readmitted at other hospitals. Targeted interventions among high-risk patients may reduce readmissions after traumatic injuries.

Keywords: Injury; Readmission; Reason; Risk factors; Trauma.

MeSH terms

Adolescent
Adult
California
Databases, Factual
Female
Humans
Injury Severity Score
Male
Middle Aged
Patient Readmission / statistics & numerical data*
Risk Factors
Wounds and Injuries / therapy*