Abstract
Background
Traumatic brain injury (TBI) is associated with functional deficits, impaired cognition,
and medical complications that continue well after the initial injury. Many patients
seek medical care at other health care facilities after discharge, rather than returning
to the admitting trauma center, making assessment of readmission rates and readmission
diagnoses 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.
Materials and methods
The Nationwide Readmission Database was queried for all patients admitted with a TBI
during the first 3 mo of 2015. Nonelective readmissions for this population were then
collected for the remainder of 2015. Patients who 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, 5296 patients (35%) required
at least 1 readmission. Forty percent of readmissions occurred within the first 30 d
after discharge from the index trauma admission. The most common primary diagnosis
on readmission was SDH, followed by septicemia, urinary tract infection, and aspiration.
Readmission rates increased with age, with 75% of readmissions occurring in patients
aged >65 y. Initial discharge to a skilled nursing facility (Relative Risk [RR], 1.60)
or leaving the hospital against medical advice (RR, 1.59) increased the risk of readmission.
Patients with fall as their mechanism of injury and a subdural hematoma were more
likely to require readmission compared with other types of mechanisms with TBI (RR,
1.59 and RR, 1.21, respectively; P < 0.001). Notably, the first readmission was to a different hospital for 39.5% of
patients and 46.9% of patients had admissions to at least one facility outside that
of their original presentation.
Conclusions
Hospital readmission is common for patients discharged after TBI. Elderly patients
who fall with resultant subdural hematoma 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.
Keywords
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Article info
Publication history
Published online: July 12, 2019
Accepted:
June 14,
2019
Received in revised form:
April 2,
2019
Received:
February 23,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
