Missed injuries and unplanned readmissions in pediatric trauma patients

Abstract

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.

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

“…The higher cost of readmission may be attributable to the increased injury severity score, likelihood of surgery, other health‐care procedures and rehabilitation following the index admission . Patients requiring readmission are likely to require surgical procedures and have long LOSs (>3 days) resulting in more expensive hospital costs at readmission …”

“…The rates, causes and implications of readmission of paediatric trauma patients are not well reported outside of the USA, where the 1‐year unplanned and planned readmission rate is 8.6% . Patients requiring readmission to hospital are typically some of the most unwell, and risk factors for readmission include intensive care admission, higher injury severity scores, intubation in the emergency department and increased hospital LOS . Within one paediatric trauma centre in the USA, the most common causes of readmission were infection and missed injury .…”

“…Patients requiring readmission to hospital are typically some of the most unwell, and risk factors for readmission include intensive care admission, higher injury severity scores, intubation in the emergency department and increased hospital LOS . Within one paediatric trauma centre in the USA, the most common causes of readmission were infection and missed injury . Patients with unplanned readmissions have been shown to be more likely to require an operation in their subsequent admission even if they did not have an operation in their initial admission.…”

“…Patients with unplanned readmissions have been shown to be more likely to require an operation in their subsequent admission even if they did not have an operation in their initial admission. More than 25% of readmitted patients require a surgical procedure, and 40% of patients have a readmission LOS greater than 3 days . Patients with a chronic condition secondary to the index trauma admission have been found to be more likely to be readmitted, and readmissions typically occur within 2 weeks of discharge …”

“…There is very little literature relating to the readmission of paediatric patients following trauma despite injury being the highest cause of hospital admission in children in Australia . Most paediatric readmission studies are limited to single institutions with small sample sizes or to selected hospitals . This research aims to examine the characteristics of readmissions following paediatric trauma in Australia over a 10‐year period, including cost, LOS and patient demographics.…”