Predictors of 30-Day Healthcare Utilization After Telemedicine Management of Minimal Traumatic Intracranial...

Introduction Telemedicine protocols for minimal traumatic intracranial hemorrhage (ICH) enable peripheral management without transfer to trauma centers, but post-discharge utilization patterns among these patients remain poorly characterized. This study evaluated factors associated with 30-day readmission and unplanned re-encounter among adult patients managed after implementation of a telemedicine minimal head bleed protocol. Methods A retrospective cohort study was conducted of adult patients with minimal traumatic ICH managed without transfer under a telemedicine protocol at a regional trauma system between July 2021 and December 2023. The primary outcome was 30-day readmission. The secondary outcome was any 30-day unplanned re-encounter. Follow-up was classified as primary care, trauma clinic, surgical subspecialty, or non-surgical subspecialty. Unadjusted comparisons used Fisher's exact testing and Mann-Whitney U testing. Exploratory logistic regression models adjusted for age, sex, and injury severity score (ISS) were performed for each follow-up category. Firth's penalized logistic regression was used as a sensitivity analysis given the limited number of readmission events. Results Among 241 adult patients, 24 (10.0%) experienced a 30-day readmission, and 61 (25.3%) experienced an unplanned re-encounter. Age, sex, and ISS were not significantly associated with either outcome. Any subspecialty follow-up was associated with increased odds of readmission (adjusted odds ratio (OR), 2.73; 95% CI, 1.10-6.77; p = 0.031), confirmed by Firth's penalized regression (OR, 2.72; 95% CI, 1.09-6.55; p = 0.033). Non-surgical subspecialty follow-up demonstrated the strongest association (adjusted OR, 7.15; 95% CI, 1.80-28.50; p = 0.005), while surgical subspecialty follow-up was not significantly associated with readmission (adjusted OR, 1.39; 95% CI, 0.47-4.08; p = 0.551). No measured variable was significantly associated with unplanned re-encounter. Re-encounters were clinically heterogeneous, including recurrent falls and neurologic symptoms. Conclusions Among patients managed via a telemedicine minimal head bleed protocol, age, sex, and ISS were not significantly associated with post-discharge healthcare utilization. Subspecialty follow-up, particularly non-surgical subspecialty care, may serve as a practical marker of post-discharge clinical complexity and could help identify patients for future evaluation of targeted transitional-care strategies. These early findings warrant further studies and validation.