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Inpatient rehabilitation utilization following firearm injury: A national trauma quality program analysis
Heather M Barnett1,2, Hiwot Weldemariam2,3, Eliza Baird-Daniel4
1Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington, USA.
Background:
Firearm injury is a common cause of disability in the United States, but there is a lack of research on the use of rehabilitation services after major and disabling firearm injuries. This study analyzed the relationship between firearm mechanism of injury and disposition to inpatient rehabilitation (IPR) after hospitalization for acute traumatic injury using national trauma data.
Objective:
We hypothesized that firearm mechanism of injury compared to all other traumatic mechanisms of injury would be associated with decreased likelihood of discharge to IPR after acute hospitalization for trauma.
Design:
Retrospective cohort study.
Setting:
Data were obtained from the Trauma Quality Program Participant Use file, which includes >700 participating Level I-IV trauma centers.
Participants:
Patients evaluated at participating trauma centers within 14 days of traumatic injury.
Exposure:
The exposure was mechanism of injury (firearm vs. other trauma).
Main Outcome:
The main outcome was acute care discharge disposition (IPR vs. other).
Results:
Among patients who were alive at hospital discharge (n = 1,010,113), individuals with firearm injury were less likely to be discharged to IPR after acute hospitalization compared to individuals with other causes of trauma (6.5% vs. 11.4%, likelihood of discharge to IPR for firearm injury vs. other injury). After adjusting for relevant sociodemographic and injury-related factors, the risk ratio (RR) of discharge to IPR was 0.84 (95% CI, 0.80-0.87) for firearm injury versus other mechanism of injury. The association of mechanism of injury with IPR discharge differed by diagnosis (p < .001 analysis of variance F-statistic).
Conclusions:
Despite a high incidence of disability and core rehabilitation diagnoses after firearm injury, there was a decreased likelihood of discharge to IPR compared to other mechanisms of trauma. Rehabilitation clinicians should consider interventions to improve equitable access to IPR for firearm injury survivors, and further research should investigate the impact of IPR on long-term outcomes in this underserved population.
