Risk factors for rehospitalization after trauma: a follow-up study

Unplanned rehospitalizations represent a heavy burden to patients, their families, and an economic burden on the healthcare system.

The aim of this study was to examine patterns of trauma-related rehospitalization within 7, 30, 60, and 90 days after initial discharge, and to assess the association between patient age and the risk of rehospitalization, while adjusting for relevant demographic and clinical factors.

This retrospective cohort study links two national databases: The Israeli National Trauma Registry and the Ministry of Health's hospitalization database. Univariate analyses (χ² tests) were performed to identify factors associated with rehospitalization at 7, 30, 60, and 90 days post-discharge. Variables significantly associated in univariate analysis were entered into separate multivariable Generalized Estimating Equations (GEE) models for each time point.

The study included 297,022 trauma patients (median age 34 years [IQR: 14-67]; 59.3% male). Most injuries were non-penetrating (88.8%), and the majority were classified as mild (ISS 1-8, 64.9%). Falls (53.0%) and road traffic accidents (23.8%) were the most common injury mechanisms. The most affected age group was 19-54 years (34.3%), and 71.3% of patients were from the Jewish population group. The rate was 4.4% for rehospitalized within seven days, 9.2% within 30 days, 12.3% within 60 days, and 14.7% within 90 days. In multivariable analysis, a clear association was observed between increasing age and higher odds of rehospitalization following discharge for trauma. Compared to the reference group (ages 0-4), older patients exhibited substantially elevated odds across all follow-up periods. For instance, patients aged 75-84 had odds ratios (ORs) of 4.39, 4.75, 4.95, and 3.33 for rehospitalization within 7, 30, 60, and 90 days, respectively. Similarly, individuals aged 85 + had ORs of 5.42, 5.68, 6.0, and 3.47, respectively. Higher odds of rehospitalization peaked at 60 days post-discharge and decreased by 90 days, suggesting possible stabilization.

Comprehensive discharge planning and a care transition system for trauma patients should involve a multidisciplinary team to address the patient's specific condition and rehospitalization risk factors, especially among older adults hospitalized following a fall.