Parreco Joshua, Alawa Nawara, Rattan Rishi, Tashiro Jun, Sola Juan E
Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
Department of Surgery, DeWitt-Daughtry Family, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
J Surg Res. 2018 Dec;232:415-421. doi: 10.1016/j.jss.2018.06.065. Epub 2018 Jul 21.
Most studies of readmission after trauma are limited to single institutions or single states. The purpose of this study was to determine the risk factors for readmission after trauma for mental illness including readmissions to different hospitals across the United States.
The Nationwide Readmission Database for 2013 and 2014 was queried for all patients aged 13 to 64 y with a nonelective admission for trauma and a nonelective readmission within 30 d. Multivariable logistic regression was performed for readmission for mental diseases and disorders.
During the study period, 53,402 patients were readmitted within 30 d after trauma. The most common major diagnostic category on readmission was mental diseases and disorders (12.1%). The age group with the highest percentage of readmissions for mental diseases and disorders was 13 to 17 y (38%). On multivariable regression, the teenage group was also the most likely to be readmitted for mental diseases and disorders compared to 18-44 y (odds ratio [OR] 0.45, P < 0.01) and 45-64 y (OR 0.24, P < 0.01). Other high-risk comorbidities included HIV infection (OR 2.4, P < 0.01), psychosis (OR 2.2, P < 0.01), drug (OR 2.0, P < 0.01), and alcohol (OR 1.4, P < 0.01) abuse.
Teenage trauma patients are at increased risk for hospital readmission for mental illness. Efforts to reduce these admissions should be targeted toward individuals with high-risk comorbidities such as HIV infection, psychosis, and substance abuse.
大多数创伤后再入院研究仅限于单一机构或单一州。本研究的目的是确定创伤后因精神疾病再入院的风险因素,包括在美国不同医院的再入院情况。
查询2013年和2014年全国再入院数据库,获取所有年龄在13至64岁之间因创伤非选择性入院且在30天内非选择性再入院的患者。对精神疾病和障碍的再入院进行多变量逻辑回归分析。
在研究期间,53402例患者在创伤后30天内再入院。再入院时最常见的主要诊断类别是精神疾病和障碍(12.1%)。精神疾病和障碍再入院百分比最高的年龄组是13至17岁(38%)。在多变量回归分析中,与18至44岁(比值比[OR]0.45,P<0.01)和45至64岁(OR 0.24,P<0.01)相比,青少年组因精神疾病和障碍再入院的可能性也最大。其他高风险合并症包括艾滋病毒感染(OR 2.4,P<0.01)、精神病(OR 2.2,P<0.01)、药物滥用(OR 2.0,P<0.01)和酒精滥用(OR 1.4,P< 0.01)。
青少年创伤患者因精神疾病再次入院的风险增加。减少这些再入院的努力应针对艾滋病毒感染、精神病和药物滥用等高风险合并症患者。