Predictors of hospital readmission after trauma: A retrospective cohort study in New Zealand

Helen Harcombe; Dave Barson; Ari Samaranayaka; Gabrielle Davie; Emma Wyeth; Sarah Derrett; Paul McBride

doi:10.1016/j.injury.2023.03.009

Predictors of hospital readmission after trauma: A retrospective cohort study in New Zealand

Injury. 2023 Mar 11:S0020-1383(23)00252-8. doi: 10.1016/j.injury.2023.03.009. Online ahead of print.

Authors

Helen Harcombe¹, Dave Barson², Ari Samaranayaka³, Gabrielle Davie⁴, Emma Wyeth⁵, Sarah Derrett⁶, Paul McBride⁷

Affiliations

¹ Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: helen.harcombe@otago.ac.nz.
² Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: dave.barson@otago.ac.nz.
³ Biostatistics Centre, Division of Health Sciences, University of Otago, Dunedin, New Zealand. Electronic address: ari.samaranayaka@otago.ac.nz.
⁴ Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: gabrielle.davie@otago.ac.nz.
⁵ Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand. Electronic address: emma.wyeth@otago.ac.nz.
⁶ Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand. Electronic address: sarah.derrett@otago.ac.nz.
⁷ Health Quality & Safety Commission, PO Box 25496, Wellington, 6146, New Zealand. Electronic address: paul.mcbride@hqsc.govt.nz.

PMID: 36931967
DOI: 10.1016/j.injury.2023.03.009

Abstract

Introduction: Understanding predictors of hospital readmission following major trauma is important as readmissions are costly and some are potentially avoidable. This study describes the incidence of, and sociodemographic, injury-related and treatment-related factors predictive of, hospital readmission related to: a) all-causes, b) the index trauma injury, and c) subsequent injury events in the 30 days and 12 months following discharge for major trauma patients nationally in New Zealand.

Methods: Data from the New Zealand Trauma Registry (NZTR) was linked with Ministry of Health hospital discharge data. Hospital readmissions were examined for all patients entered into the NZTR for an injury event between 1 January and 31 December 2018. Readmissions were examined for the 12-months following the discharge date for participant's index trauma injury.

Results: Of 1986 people, 42% had ≥1 readmission in the 12 months following discharge; 15% within 30 days. Seven percent had ≥1 readmission related to the index trauma within 30 days of discharge; readmission was 3.43 (95% CI 1.87, 6.29) times as likely if the index trauma was self-inflicted compared to unintentional, and 1.64 (95% CI 1.15, 2.34) times as likely if the index trauma involved intensive care unit admission. Those admitted to hospital for longer for their index trauma were less likely to be readmitted due to their index trauma injury within 30 days compared to those admitted for 0-1 day. Seventeen percent were readmitted for a subsequent injury event within 12 months, with readmission more likely for older people (>65 years), those with comorbidities, Māori compared with non-Māori and those with higher trauma injury severity.

Conclusion: A substantial proportion of people are readmitted after discharge for major trauma. Factors identified in this study will be useful to consider when developing interventions to reduce preventable readmissions including those related to the index trauma injury, readmissions from other causes and subsequent injury-related readmissions. Further research specifically examining planned and unplanned readmissions is warranted.

Keywords: Hospital; Predictors; Prevention; Readmission; Subsequent injury; Trauma.