A. Brito1, L. N. Godat2, A. E. Berndtson2, J. Doucet2, A. M. Smith2, T. W. Costantini2 1University Of California – San Diego,General Surgery,San Diego, CA, USA, 2University Of California – San Diego,Division Of Trauma, Surgical Critical Care, Burns And Acute Care Surgery – Department Of Surgery,San Diego, CA, USA
Introduction: Traumatic brain injury (TBI) is associated with functional deficits, impaired cognition and medical comorbidities that continue well after the initial injury. Many patients seek medical care at other healthcare facilities following discharge, rather than returning to the admitting trauma center, making assessment of readmission rates difficult to determine. The objective of this study was to determine the incidence and factors associated with readmission to any acute care hospital after an index admission for TBI.
Methods: The Nationwide Readmission Database was queried for all patients admitted with a TBI during the first 3 months of 2015. Readmissions for this population were then collected for the remainder of 2015. Patients that died during the index admission were excluded. Demographic data, injury mechanism, type of TBI, the number of readmissions, days from discharge to readmission, readmission diagnosis and mortality were studied.
Results: Of the 15,277 patients with an index admission for TBI, 5,296 patients (35%) required at least 1 readmission. The number of readmissions ranged from 1 to 14. Twenty six percent of readmissions occurred within the first 2 weeks after discharge from the index trauma admission (see Figure). Patients with subdural hematoma (SDH) were more likely to require readmission compared to other types of TBI (RR 1.21, p<0.001). The most common primary diagnosis on readmission was SDH, followed by septicemia, urinary tract infection, and aspiration. The 3 most frequent injury mechanisms associated with readmission were fall (86%), motor vehicle crashes (7%) and assaults (4%). Readmission rates increased with age, with 94% occurring in patients over the age of 45 and 75% in patients >65 years. Mortality ranged from 6-14% on depending on the number of subsequent readmissions after TBI.
Conclusion: Hospital readmission is common for patients discharged following TBI. Elderly patients who fall with resultant SDH are at especially high risk for complications and readmission. Understanding potentially preventable causes for readmission can be used to guide discharge planning pathways to decrease morbidity in this patient population.
