Rosenthal Martin G, Crandall Marie L, Tepas Joseph J, Kerwin Andrew J
From the University of Florida (M.G.R., M.C., J.T., A.K.), Jacksonville, Florida.
J Trauma Acute Care Surg. 2017 Jul;83(1):135-138. doi: 10.1097/TA.0000000000001540.
In an era of decreasing reimbursements, the incentive to decrease readmissions has never been greater. It has been suggested that trauma readmission is an indicator of poor hospital care or fragmented discharge. Even though trauma readmissions are relatively low, readmissions add significant cost, tie up already limited resources and lead to worse outcomes, including mortality. The literature on trauma readmissions is sparse, and the reasons and risk factors for readmission are inconsistent across studies. If readmissions are to serve as useful indicators of quality of care, we must elucidate factors that may predict readmissions.
We performed a retrospective review of all admissions to our urban Level I trauma center from July 1, 2012, to June 30, 2015. All patients aged 16 years or older who were discharged alive were included. We identified all unplanned readmissions that occurred within 30 days of discharge and performed an extensive chart review to determine the reasons for readmission. We performed univariate and multivariable analyses.
We identified 6,026 index trauma admissions, with 158 (2.6%) unplanned readmissions within 30 days of discharge. The most common reasons for readmission were disease/symptom progression (30.2%), wound complications (28.9%), and pain control (11.8%). On multivariate analysis, only Injury Severity Score (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00-1.05; p=0.016), penetrating injuries (OR, 1.9; 95% CI, 1.12-3.24; p=0.018), and smoking (OR, 1.73; 95% CI, 1.05-2.86; p=0.031) were found to be significant. Hospital length of stay, insurance status, and race were not significant.
In a resource-limited environment, we expected a lack of access to care would lead to increased trauma readmissions; however, we were still able to achieve similar readmission rates, irrespective of insurance status and race. Our trauma readmission rate is low and consistent with previously published studies. Our results at our Level I trauma center support previously published studies that found Injury Severity Score and penetrating injury to be risk factors for readmission; however, more ubiquitous risk factors, such as hospital length of stay and discharge destination, were not significant. With no consensus on the risk factors for unplanned early trauma readmission, individual trauma centers should evaluate their specific risk factors for readmission to improve patient outcomes and decrease hospital costs.
Care management, level IV; Epidemiologic, level IV.
在报销费用不断减少的时代，降低再入院率的动机从未如此强烈。有人认为创伤再入院是医院护理不佳或出院安排不连贯的一个指标。尽管创伤再入院率相对较低，但再入院会增加大量成本，占用本就有限的资源，并导致包括死亡率在内的更差结果。关于创伤再入院的文献稀少，且不同研究中再入院的原因和风险因素并不一致。如果再入院要作为护理质量的有用指标，我们必须阐明可能预测再入院的因素。
我们对2012年7月1日至2015年6月30日期间入住我们城市一级创伤中心的所有患者进行了回顾性研究。纳入所有年龄在16岁及以上且存活出院的患者。我们确定了出院后30天内发生的所有非计划再入院情况，并进行了广泛的病历审查以确定再入院原因。我们进行了单因素和多因素分析。
我们确定了6026例首次创伤入院患者，其中158例（2.6%）在出院后30天内发生非计划再入院。再入院最常见的原因是疾病/症状进展（30.2%）、伤口并发症（28.9%）和疼痛控制（11.8%）。多因素分析显示，只有损伤严重程度评分（优势比[OR]，1.02；95%置信区间[CI]，1.00 - 1.05；p = 0.016）、穿透伤（OR，1.9；95% CI，1.12 - 3.24；p = 0.018）和吸烟（OR，1.73；95% CI，1.05 - 2.86；p = 0.031）具有统计学意义。住院时间、保险状况和种族无统计学意义。
在资源有限的环境中，我们预计获得护理的机会不足会导致创伤再入院率增加；然而，无论保险状况和种族如何，我们仍能实现相似的再入院率。我们的创伤再入院率较低，与先前发表的研究一致。我们一级创伤中心的结果支持先前发表的研究，即损伤严重程度评分和穿透伤是再入院的风险因素；然而，更普遍的风险因素，如住院时间和出院目的地，并无统计学意义。由于对于非计划早期创伤再入院的风险因素尚无共识，各创伤中心应评估其再入院的特定风险因素，以改善患者预后并降低医院成本。
护理管理，四级；流行病学，四级。
