The Effect of Hospital Trauma Level on Odds of Non-home Discharge from Hospital Following Dens Fracture

Dens fractures are cervical spine injuries with high morbidity and mortality in the elderly. Many patients require discharge to rehabilitation facilities or skilled nursing care, which impacts patient recovery, healthcare system resource allocation, and prognosis. This study evaluated the effect of trauma center level designation on discharge disposition in patients with dens fractures.

We conducted a retrospective study using data from a Texas State Trauma Registry from 2020 to 2022. Patient demographics, injury characteristics, and outcomes were queried in patients with dens fractures. Discharge home was defined as home discharge with or without home health services. Non-home discharge (NHD) was defined as discharge to another facility. Differences in discharge disposition were analyzed using adjusted binary and multinomial logistic regressions with 95% confidence intervals. Baseline characteristics were analyzed with chi-square and Kruskal-Wallis tests with post-hoc Dunn test for pairwise comparisons.

A total of 904 patients were included. After excluding patients who died during hospitalization or were discharged to locations not included in the analysis (e.g., against medical advice, jail, or psychiatric facilities), 433 (52.9%) patients were discharged home while 385 (47.1%) patients had a NHD. Patients treated at level II trauma centers were almost twice as likely to have a NHD compared to patients who were treated at a level I (OR=1.98; 95% CI, 1.39-2.83; p<0.001). Lower-level trauma centers combined (levels II to IV) also had higher odds of a NHD compared to patients who were treated at a level I trauma center (OR=2.03, 95% CI, 1.47-2.79; p<0.001). These findings remained significant when patients discharged from the ED without inpatient admission were excluded (OR=1.52; 95% CI, 1.08-2.14; p=0.016).

Patients with dens fractures treated at Level I trauma centers were significantly more likely to undergo home discharge than those treated at lower-level centers. Trauma center level may play an important role in discharge outcomes for this high-risk population. Further research is needed to identify specific practices contributing to this difference in discharge disposition.