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Risk factors for nonelective 30-day readmission in pediatric assault victims
Jessica L Buicko1, Joshua Parreco1, Brent A Willobee1
1Division of Pediatric Surgery, DeWitt-Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, USA.
Insights
Pediatric assault victims have a 3.23% readmission rate, with repeated assault being a common reason. Key risk factors for readmission include prolonged hospital stay, psychoses, and weight loss.
Area of Science:
- Trauma Surgery
- Pediatric Surgery
- Public Health
Background:
- Hospital readmissions in trauma patients are linked to increased morbidity and healthcare costs.
- Early hospital readmission data in pediatric trauma patients is scarce.
- Readmission rates are increasingly used as hospital quality indicators.
Purpose of the Study:
- To determine national readmission rates in pediatric assault victims.
- To identify common readmission diagnoses in this population.
- To recognize risk factors for readmission.
Main Methods:
- Utilized the 2013 Nationwide Readmission Database (NRD).
- Included pediatric patients (<18 years) with non-elective assault admissions.
- Employed multivariate logistic regression to identify 30-day readmission risk factors.
Main Results:
- A total of 4050 pediatric assault victims were analyzed; 3.23% were readmitted within 30 days.
- Readmission for repeated assault occurred in 24.22% of readmitted patients.
- Significant risk factors for readmission included length of stay >7 days, psychoses, and weight loss.
Conclusions:
- Readmission among pediatric assault victims poses a substantial resource burden.
- Identifying risk factors like psychoses, weight loss, and prolonged hospitalization can improve patient outcomes.
- Enhanced discharge planning and support are crucial for reducing readmissions and costs.
Purpose:
Hospital readmission in trauma patients is associated with significant morbidity and increased healthcare costs. There is limited published data on early hospital readmission in pediatric trauma patients. As presently in healthcare outcomes and readmissions rates are increasingly used as hospital quality indicators, it is paramount to recognize risk factors for readmission. We sought to identify national readmission rates in pediatric assault victims and identify the most common readmission diagnoses among these patients.
Methods:
The Nationwide Readmission Database (NRD) for 2013 was queried for all patients under 18years of age with a non-elective admission with an E-code that is designed as assault using National Trauma Data Bank Standards. Multivariate logistic regression was implemented using 18 variables to determine the odds ratios (OR) for non-elective readmission within 30-days.
Results:
There were 4050 pediatric victims of assault and 92 (2.27%) died during the initial admission. Of the surviving patients 128 (3.23%) were readmitted within 30days. Of these readmitted patients 24 (18.75%) were readmitted to a different hospital and 31 (24.22%) were readmitted for repeated assault. The variables associated with the highest risk for non-elective readmission within 30-days were: length of stay (LOS) >7days (OR 3.028, p<0.01, 95% CI 1.67-5.50), psychoses (OR 3.719, p<0.01, 95% CI 1.70-8.17), and weight loss (OR 4.408, p<0.01, 95% CI 1.92-10.10). The most common readmission diagnosis groups were bipolar disorders (8.2%), post-operative, posttraumatic, or other device infections (6.2%), or major depressive disorders and other/unspecified psychoses (5.2%).
Conclusions:
Readmission after pediatric assault represents a significant resource burden and almost a quarter of those patients are readmitted after a repeated assault. Understanding risk factors and reasons for readmission in pediatric trauma assault victims can improve discharge planning, family education, and outpatient support, thereby decreasing overall costs and resource burden. Psychoses, weight loss, and prolonged hospitalization are independent prognostic indicators of readmission in pediatric assault patients.
Level Of Evidence:
Level IV - Prognostic and Epidemiological - Retrospective Study.
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