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Hospital Readmissions after Pediatric Trauma
- Publication Year :
- 2018
-
Abstract
- OBJECTIVES To determine the rate, etiology, and timing of unplanned and planned hospital readmissions and to identify risk factors for unplanned readmission in children who survive a hospitalization for trauma. DESIGN Multicenter retrospective cohort study of a probabilistically linked dataset from the National Trauma Data Bank and the Pediatric Health Information System database, 2007-2012. SETTING Twenty-nine U.S. children's hospitals. PATIENTS 51,591 children (< 18 yr at admission) who survived more than or equal to a 2-day hospitalization for trauma. MEASUREMENTS AND MAIN RESULTS The primary outcome was unplanned readmission within 1 year of discharge from the injury hospitalization. Secondary outcomes included any readmission, reason for readmission, time to readmission, and number of readmissions within 1 year of discharge. The primary exposure groups were isolated traumatic brain injury, both traumatic brain injury and other injury, or nontraumatic brain injury only. We hypothesized a priori that any traumatic brain injury would be associated with both planned and unplanned hospital readmission. We used All Patient Refined Diagnosis Related Groups codes to categorize readmissions by etiology and planned or unplanned. Overall, 4,301/49,982 of the patients (8.6%) with more than or equal to 1 year of observation time were readmitted to the same hospital within 1 year. Many readmissions were unplanned: 2,704/49,982 (5.4%) experienced an unplanned readmission in the first year. The most common reason for unplanned readmission was infection (22%), primarily postoperative or posttraumatic infection (38% of readmissions for infection). Traumatic brain injury was associated with lower odds of unplanned readmission in multivariable analyses. Seizure or RBC transfusion during the index hospitalization were the strongest predictors of unplanned, earlier, and multiple readmissions. CONCLUSIONS Many survivors of pediatric trauma experience unplanned, and potentially preventable, hospital readmissions in the year after discharge. Identification of those at highest risk of readmission can guide targeted in-hospital or postdischarge interventions.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Databases, Factual
Traumatic brain injury
Poison control
Critical Care and Intensive Care Medicine
Patient Readmission
Occupational safety and health
Article
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Risk Factors
030225 pediatrics
Injury prevention
medicine
Humans
Child
Retrospective Studies
business.industry
030208 emergency & critical care medicine
Retrospective cohort study
medicine.disease
Hospitals, Pediatric
United States
Logistic Models
Child, Preschool
Pediatrics, Perinatology and Child Health
Emergency medicine
Etiology
Wounds and Injuries
Female
business
Cohort study
Pediatric trauma
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....50dd29c1f8ccfc74d491e28754752aeb