Early unplanned hospital readmission after acute traumatic injury: the experience at a state-designated level-I trauma center

Copertino, Leonard Michael; McCormack, Jane E.; Rutigliano, Daniel N.; Huang, Emily; Shapiro, Marc J.; Vosswinkel, James A.; Jawa, Randeep S.

doi:10.1016/j.amjsurg.2014.06.026

Cited by 27 publications

(20 citation statements)

References 15 publications

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“…[9–12] As in many of the adult studies, our readmitted patients had higher ISS, LOS, and also required operative intervention. [1,2,4] However, in contrast to adult series, only ISS was associated with increased risk of readmission after multivariate analysis in our patient population.…”

Section: Discussioncontrasting

confidence: 74%

“…Reported readmissions rates for adult trauma patients have ranged from 4–8% in the literature. [1–3] Risk factors for adult trauma readmissions include medical co-morbidities, higher injury severity score (ISS), surgical site infection, length of stay (LOS), significant abdominal injury, and discharge to a skilled nursing facility. [1,2,4] Reported missed injury rates in adult trauma patients have ranged from 8–15%.…”

Section: Introductionmentioning

confidence: 99%

“…[1–3] Risk factors for adult trauma readmissions include medical co-morbidities, higher injury severity score (ISS), surgical site infection, length of stay (LOS), significant abdominal injury, and discharge to a skilled nursing facility. [1,2,4] Reported missed injury rates in adult trauma patients have ranged from 8–15%. [5–7] Risk factors have included polytrauma, increased ISS, longer LOS, and significant traumatic brain injuries.…”

Section: Introductionmentioning

confidence: 99%

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Missed injuries and unplanned readmissions in pediatric trauma patients

Choi

Keller

2017

Journal of Pediatric Surgery

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Background We sought to determine the incidence and characteristics of missed injuries and unplanned readmissions at a Level-1 pediatric trauma center. Methods We conducted a retrospective review of all trauma patients who presented to our ACS-Verified Level-1 pediatric trauma center from 2009–2014. Results Overall, there were 27 readmissions and 27 missed injuries (0.38%). Patients who were unplanned readmissions had a greater Injury Severity Score (ISS) (8.6 vs 5.2, p=0.03), had longer hospitalizations (4.9 vs 2.5 days, p=0.02), and were more likely to have required operative intervention (51.9% vs 32.3%, p=0.04). Similarly, patients identified with missed injuries had a higher ISS (15.2 vs 5.2, p<0.0001), greater length of stay (12.7 vs 2.5 days, p<0.0001), and were also more likely to be intubated (25.9% vs 3.6%, p <0.0001) or require critical care (48.1% vs 10.3%, p<0.0001). Seven missed injuries were in patients who were deemed non-accidental trauma (25.9%) and significantly altered their hospital course while 10 patients (37%) required operative intervention. On multivariate analysis, only ISS was found to be an independent risk factor for readmissions and missed injuries. Conclusions Missed injuries and unplanned readmissions were rare occurrences among our pediatric patient population. These events, however, did result in longer hospitalizations and additional procedures. Patients with multisystem injuries and compromised physical exam are at higher risk.

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Section: Discussioncontrasting

confidence: 74%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Missed injuries and unplanned readmissions in pediatric trauma patients

Choi

Keller

2017

Journal of Pediatric Surgery

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“…The researchers stated that trauma patients are infrequently readmitted, the index admission to a surgical service reduces the risk of readmission, and earlier medical follow-up should be considered. 58 …”

Section: Genetic Susceptibility Related To Sepsismentioning

confidence: 99%

Review: Immunology of Sinusitis, Trauma, Asthma, and Sepsis

Frieri¹,

Kumar

Boutin

2015

Allergy�Rhinol (Providence)

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Background:This review article is important for allergists/immunologists and otolaryngologists. It discussed chronic rhinosinusitis, epidemiology, pathogenesis, innate adaptive immunology, nuclear factor–kappa B related to inflammation, sepsis, complement, reactive oxygen species, asthma, sinusitis, elderly pathogenesis, oxidative stress, depression, seasonal variation, vitamin D, genetic susceptibility and sepsis, hereditary angioedema related to trauma and stress.Objective:The objective of this review is to link chronic rhinosinusitis, epidemiology, innate and adaptive immunology, NF-kappa B related to inflammation, sepsis, complement, reactive oxygen species, asthma and sinusitis.Methods:A literature search was conducted from several articles, prospective studies, recent reviews and earlier reports. A synergistic relationship develops between activation of the innate immune system and the loss of organ barrier functions. Many complex factors, such as genetics, physical agents, mediators in the development of organ failure both in asthma, sinusitis, stress, depression and trauma, leading to posttraumatic organ failure. Asthma and sepsis, a common condition encountered in hospital environments remains an important cause of death at intensive care units where allergists/immunologists and otolaryngologists are frequently consulted. The patient's immune surveillance could fail to eliminate the pathogen, allowing it to spread and there is a proinflammatory mediator release with inappropriate activation.Conclusion:This review discussed chronic rhinosinusitis, sinusitis related to trauma, the innate and adaptive immunology, NF-kappa B related to inflammation, sepsis, complement, inflammation, reactive oxygen species, asthma pathogenesis, and asthma in the elderly, oxidative stress, depression, seasonal variation and vitamin D, cytokines, genetic susceptibility related to sepsis, hereditary angioedema related to trauma and stress.

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“…Trauma patients, both adult and paediatric, make up a small proportion of emergency department presentations and hospital admissions and generally have lower readmission rates than the general population . However, in the adult population, readmission is a poor prognostic indicator and is associated with increased hospital length of stay (LOS) as well as a higher mortality rate (1.5–4.8%) …”

mentioning

confidence: 99%

Hospital readmissions in paediatric trauma patients: A 10‐year Australian review

Unsworth

Curtis

Mitchell

2018

J Paediatrics Child Health

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Aim: Readmission of paediatric trauma patients is associated with increased hospital length of stay, additional operative procedures and significant costs to the health-care system. The rates and causes of readmission of paediatric trauma patients are not well reported outside of the USA or single centres. This nation-wide study is the first in Australia to examine the readmission rates, costs and characteristics of Australian paediatric trauma patients. Methods: This was a retrospective examination of linked hospitalisation and mortality data for injured children aged 16 or younger from 1 July 2001 to 30 June 2012, readmitted to hospital within 28 days of discharge. Data including injury severity, nature of injury, episodes of care and costs were extracted from hospitalisation data. Results: There were 37 603 injury children aged ≤16 years readmitted to hospital within 28 days during the 10-year period, a readmission rate of 5.5%. The most common principal injury requiring readmission was fracture (52.6%) and burns (19.3%). A total of 66% of all patients had a readmission diagnosis of injury, complication of their initial injury or complication of surgical and medical care; 30% were readmitted for a specific procedure or follow-up care. The total cost of readmissions was AU$108 million. Conclusions: Hospital readmission rates of paediatric trauma patients in Australia are due to injury or a complication of injury and are associated with significant costs. Early identification of at-risk patients and the prevention of complications are needed to prevent the ongoing burden of readmission.

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Early unplanned hospital readmission after acute traumatic injury: the experience at a state-designated level-I trauma center

Cited by 27 publications

References 15 publications

Missed injuries and unplanned readmissions in pediatric trauma patients

Missed injuries and unplanned readmissions in pediatric trauma patients

Review: Immunology of Sinusitis, Trauma, Asthma, and Sepsis

Hospital readmissions in paediatric trauma patients: A 10‐year Australian review

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