Abstract
IntroductionTrauma patients frequently return to an emergency department (ED) soon after discharge; often for non-urgent reasons. Social factors contribute to higher ED usage. At present, there is no standardized system for reporting of ED visits and readmissions among trauma care. We hypothesized that victims of violent crime suffer from many early post-discharge adverse events that has not been captured by current methods.MethodsWe prospectively consented and enrolled injured patients from January 1st, 2019 to December 31st, 2019. We documented 30-day post-discharge events using post-discharge phone calls and detailed chart abstraction. Patients were categorized as victims of violence (VV) or unintentional traumatic injury (UT).ResultsDuring the study period, 444 patients were enrolled. Fifty-one (11.5%) were victims of violence and 393 (88.5%) experienced unintentional injuries. The VV patients were younger (40.10 vs 60.36; p<0.0001), and more predominantly male (92.16% vs 57.51%; p<0.0001). Total injury severity score (ISS), critical care length of stay (LOS), and total LOS were similar. VV patients were more likely discharged home (70.59% vs 55.47%; p=0.0403). They were significantly more likely to return to an emergency department (47.06% vs 23.16%; p<0.0005) and had more total number of ED visits per patient. Readmission rates, however, were not different (21.57% vs 16.28%; p=NS). The VV patients more frequently were underinsured (72.5%, vs 20.6%, p<0.005).DiscussionVictims of violence presented to the ED significantly more often, despite similar injury scores, LOS, and being of younger age. Of these patients, only 26.2% of ED presentations resulted in readmission, suggesting the majority of patient complaints may have been able to be managed in an office-based setting. VV had significantly more underinsured or subsidized patients. Victims of violence are vulnerable and may benefit from more resources provided in the early post-discharge period.
Highlights
Trauma patients frequently return to an emergency department (ED) soon after discharge; often for nonurgent reasons
They were significantly more likely to return to an emergency department (47.06% vs 23.16%; p
Victims of violence were significantly more likely to return to an emergency department within 30 days of discharge (VV 24/51 (47.1%) vs unintentional traumatic injury (UT) 91/393 (23.2%), p
Summary
We prospectively consented and enrolled injured patients from January 1st, 2019 to December 31st, 2019. We documented 30-day post-discharge events using post-discharge phone calls and detailed chart abstraction. From January 1st, 2019 to December 31st, 2019 all injured patients at least 18 years old were prospectively reviewed. Those who were evaluated by the trauma service and warranted an inpatient admission for their injuries were included. Patients were recruited as subjects during their index trauma admission. Patients were contacted and interviewed for discharge disposition, unplanned hospital or emergency department visits, admissions, and any interventions or procedures experienced since discharge. Local electronic medical records were reviewed for available details and documented post-acute events
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