Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
Division of Trauma and Surgical Critical Care, Department of Surgery, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida.
J Surg Res. 2020 Jun;250:59-69. doi: 10.1016/j.jss.2019.12.029. Epub 2020 Feb 1.
Previous studies have shown that a notable portion of patients who are readmitted for reinjury after penetrating trauma present to a different hospital. The purpose of this study was to identify the risk factors for reinjury after penetrating trauma including reinjury admissions to different hospitals.
The 2010-2014 Nationwide Readmissions Database was queried for patients surviving penetrating trauma. E-codes identified patients subsequently admitted with a new diagnosis of blunt or penetrating trauma. Univariable analysis was performed using 44 injury, patient, and hospital characteristics. Multivariable logistic regression using significant variables identified risk factors for the outcomes of reinjury, different hospital readmission, and in-hospital mortality after reinjury.
There were 443,113 patients identified. The reinjury rate was 3.5%. Patients presented to a different hospital in 30.0% of reinjuries. Self-inflicted injuries had a higher risk of reinjury (odds ratio [OR]: 2.66, P < 0.05). Readmission to a different hospital increased risk of mortality (OR: 1.62, P < 0.05). Firearm injury on index admission increased risk of mortality after reinjury (OR: 1.94, P < 0.05).
This study represents the first national finding that one in three patients present to a different hospital for reinjury after penetrating trauma and have a higher risk of mortality due to this fragmentation of care. These findings have implications for quality and cost improvements by identifying areas to improve continuity of care and the implementation of penetrating injury prevention programs.
先前的研究表明，穿透性创伤后再次因受伤而再次入院的患者中，有相当一部分人会前往不同的医院就诊。本研究的目的是确定穿透性创伤后再次受伤的风险因素，包括因受伤而前往不同医院就诊。
从 2010 年至 2014 年全国再入院数据库中查询了存活的穿透性创伤患者。E 代码确定了随后以新诊断的钝器或穿透性创伤入院的患者。使用 44 项损伤、患者和医院特征进行单变量分析。使用有显著意义的变量进行多变量逻辑回归，确定了再受伤、不同医院再入院和再受伤后住院内死亡率的结果的风险因素。
共确定了 443113 例患者。再受伤率为 3.5%。在 30.0%的再受伤中，患者前往了不同的医院。自残受伤的再受伤风险更高（优势比 [OR]：2.66，P<0.05）。在不同医院的再次入院增加了死亡率的风险（OR：1.62，P<0.05）。索引入院时的火器伤增加了再受伤后的死亡率风险（OR：1.94，P<0.05）。
这项研究是首次全国性研究发现，三分之一的穿透性创伤患者会前往不同的医院再次因受伤而就诊，由于这种护理的碎片化，他们的死亡率风险更高。这些发现对于通过确定改善连续性护理和实施穿透性损伤预防计划的领域，对提高质量和降低成本具有重要意义。
