The truth about trauma readmissions

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• 作者：Olubode A. Olufajo ; M.D. ; M.P.H.^a ; ^b ; ^{oao777@mail.harvard.edu" class="auth_mail" title="E-mail the corresponding author} ; Zara Cooper ; M.D. ; M.Sc.^a ; ^b ; Brian K. Yorkgitis ; D.O.^a ; Peter A. Najjar ; M.D.^b ; David Metcalfe ; L.L.B. ; M.B.Ch.B.^b ; Joaquim M. Havens ; M.D.^a ; ^b ; Reza Askari ; M.D.^a ; ^b ; Gabriel A. Brat ; M.D. ; M.Sc.^a ; Adil H. Haider ; M.D. ; M.P.H.^a ; ^b ; Ali Salim ; M.D.^a ; ^b
• 关键词：Injury ; Readmission ; Reason ; Risk factors ; Trauma
• 刊名：The American Journal of Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：211
• 期：4
• 页码：649-655
• 全文大小：256 K

文摘

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.