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Rates, patterns, and determinants of unplanned readmission after traumatic injury: a multicenter cohort study
Lynne Moore1, Henry Thomas Stelfox, Alexis F Turgeon
1*Department of Social and Preventative Medicine, Université Laval, Québec, Canada †Unité de traumatologie-urgence-soins intensifs, CHU de Québec - H^opital Enfant-Jésus, Université Laval, Québec, Canada ‡Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), University of Calgary, Calgary, Alberta, Canada §Department of Anesthesiology, Division of Critical Care Medicine, Université laval, Québec, Québec, Canada ¶Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; and ∥Institut national d'excellence en santé et en services sociaux, Montréal, Québec, Canada.
Objective:
This study aimed to (i) describe unplanned readmission rates after injury according to time, reason, and place; (ii) compare observed rates with general population rates, and (iii) identify determinants of 30-day readmission.
Background:
Hospital readmissions represent an important burden in terms of mortality, morbidity, and resource use but information on unplanned rehospitalization after injury admissions is scarce.
Methods:
This multicenter retrospective cohort study was based on adults discharged alive from a Canadian provincial trauma system (1998-2010; n = 115,329). Trauma registry data were linked to hospital discharge data to obtain information on readmission up to 12 months postdischarge. Provincial admission rates were matched to study data by age and gender to obtain expected rates. Determinants of readmission were identified using multiple logistic regression.
Results:
Cumulative readmission rates at 30 days, 3 months, 6 months, and 12 months were 5.9%, 10.9%, 15.5%, and 21.1%, respectively. Observed rates persisted above expected rates up to 11 months postdischarge. Thirty percent of 30-day readmissions were due to potential complications of injury compared with 3% for general provincial admissions. Only 23% of readmissions were to the same hospital. The strongest independent predictors of readmission were the number of prior admissions, discharge destination, the number of comorbidities, and age.
Conclusions:
Unplanned readmissions after discharge from acute care for traumatic injury are frequent, persist beyond 30 days, and are often related to potential complications of injury. Several patient-, injury-, and hospital-related factors are associated with the risk of readmission. Injury readmission rates should be monitored as part of trauma quality assurance efforts.