Association Among Fragmented Trauma Care, Mortality, and Major Complications: Optimizing Care for the Injured Beyond...

This study aimed to characterize the nationwide burden of fragmented care among adult trauma patients and evaluate associations between readmission to index versus nonindex hospital and mortality, major complications, and other outcomes during readmission.

Fragmented care from readmission to a nonindex hospital has been associated with worse outcomes across multiple disciplines. The nonelective nature of traumatic injury and the high prevalence of social vulnerability risk factors renders trauma patients at high risk of fragmented care.

In this retrospective observational cohort study using the 2019 and 2020 National Readmissions Database, we identified the rate of fragmented care among adult trauma patients who experience a 90-day readmission and the most prevalent principal readmission diagnoses. Multivariable regression analysis using least absolute shrinkage and selector regression and 10-fold cross-validation identified risk factors for readmission to nonindex hospitals and the associations between readmission to nonindex hospitals and outcomes.

Among 906,531 injured adult patients, 108,246 (11.9%) experienced 90-day readmission after discharge from initial hospitalization. Twenty-eight percent (n = 30,153) were readmitted to a nonindex hospital. Septicemia was the most common principal readmission diagnosis, and urinary tract infections and pneumonia were the most common concomitant infectious diagnoses. Compared with patients readmitted to their index hospital, those readmitted to a nonindex hospital had 11% higher adjusted odds of mortality [OR (95% confidence interval {CI}): 1.11 (1.02-1.21)] and 12% higher adjusted odds of major complications [OR (95% CI): 1.12 (1.07-1.17)].

Ninety-day readmissions are not uncommon among adult trauma patients, and many experience fragmented care. Fragmented care is associated with higher odds of mortality and major complications during readmission. There is an urgent need to identify modifiable risk factors for readmission during the index injury hospitalization and develop strategies to prevent readmission and the consequences of fragmented care.