Emergency department return visits and hospital admissions in trauma team assessed patients initially discharged from the emergency department: A population-based cohort study

Evans, Christopher; Li, Wenbin; Balari, Pardis; Ma, Jinghong; Brogly, Susan B.

doi:10.1097/ta.0000000000003583

Cited by 4 publications

(3 citation statements)

References 27 publications

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“…In a recent Canadian study, it was reported that 18% of their trauma population had at least one ED return visit within 2 weeks, 24 in contrast to older studies that have reported 14% re-attendance over a 30-day follow-up period. 25,26 The cohort of patients with blunt chest trauma in our study demonstrated an 18% unplanned re-attendance rate at the ED within 12 weeks.…”

Section: Discussionmentioning

confidence: 86%

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

Battle¹,

Hutchings²,

Rafferty³

et al. 2023

J Trauma Acute Care Surg

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Background Whilst much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the healthcare utilisation outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the UK. Methods This was a longitudinal, retrospective, single-centre, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage (SAIL) databank for admissions to a trauma unit in the Wales, between 1st January 2016 and 31st December 2020. All patients aged ≥16 years with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data was analysed using a negative binomial regression model. Results 3205 presentations to the ED were included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0-3 rib fractures. 4% of the cohort were reported to have COPD, and 4% using pre-injury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period post-injury, compared with the 12-week period pre-injury (OR: 1.63 95% CI: 1.33-1.99, p < 0.001; OR: 1.28, 95% CI: 1.14-1.43, p < 0.001; OR: 1.02. 95% CI: 1.01-1.02, p < 0.001 respectively). Risk of healthcare resource utilisation increased significantly with each additional year of age, COPD and pre-injury anti-coagulant use (all p < 0.05). Social deprivation and number of rib fracture did not impact outcomes. Conclusion The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital. Study type and level of evidence Prognostic / epidemiological. Level IV

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Section: Discussionmentioning

confidence: 86%

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

Battle¹,

Hutchings²,

Rafferty³

et al. 2023

J Trauma Acute Care Surg

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“…ICES data sets used in this study include the Registered Persons Database for demographic information and vital status, the Ontario Trauma Registry (OTR) for injury information, the Canadian Institute of Health Care Information Discharge Abstract Database for further inpatient diagnostic and procedural information and comorbidities (measured with the Elixhauser Comorbidity Index score, 18,19 3-year look-back period), and the Ontario Mental Health Reporting System for mental health admissions, as well as the National Ambulatory Care Reporting System and OHIP for outpatient mental health service provided by emergency physicians or family physician or psychiatrists, respectively (Supplementary Digital Content, Supplementary Table 1, http://links.lww.com/TA/C752). ICES databases have previously been shown to be inclusive of our province's entire emergency system (covering >99% of emergency departments) and to have high data linkage rates (>95%) and internal diagnostic validity (>90% compared with medical record abstraction) 20–23 …”

Section: Methodsmentioning

confidence: 99%

“…ICES databases have previously been shown to be inclusive of our province's entire emergency system (covering >99% of emergency departments) and to have high data linkage rates (>95%) and internal diagnostic validity (>90% compared with medical record abstraction). [20][21][22][23]…”

Section: Settingmentioning

confidence: 99%

Outpatient mental health service use in major trauma survivors: A population-based cohort study from Ontario, Canada

Evans¹,

Jagelavičiūtė

et al. 2022

J Trauma Acute Care Surg

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BACKGROUND:Mental health is recognized as an important outcome in major trauma survivors. There are limited data on how and when survivors access mental health services. Our objectives were to determine the frequency, timing, and factors associated with outpatient mental health service utilization in major trauma survivors. METHODS:We conducted a population-based cohort study using linked administrative data on patients treated for major trauma in Ontario between 2009 and 2017. All trauma survivors were included in the cohort, and composite rates of outpatient mental health service use (family doctor, psychiatrist, or emergency department visits) were compared in the 3 years preinjury and postinjury. We used an exposure crossover study design and negative binomial regression with generalized estimating equations for the analysis. Multivariate logistic regression analyses were used to identify patient characteristics associated with mental health service use during the follow-up period. RESULTS:There were 37,260 patients included in the cohort, predominantly men (70.8%) from urban areas (84.8%) suffering blunt trauma (89.7%). Among the patients, 47.4% used mental health services during the preinjury period and 61.8% during the postinjury period (absolute increase of 14.4%). Compared with the 3 years preinjury, the rate of mental health service use increased by 80% (rate ratio, 1.8; 95% confidence interval, 1.75-1.77) in the 3 years following injury. Most survivors (62.2%) used services within the first year following discharge. Postinjury mental health service use (adjusted odds ratio, 3.4; 95% confidence interval, 2.2-3.7) was most strongly associated with preinjury mental health service use. CONCLUSION:Preinjury and postinjury outpatient mental health service use is common in trauma patients, with preinjury service use predictive of ongoing service use. Mental health concerns should be an expected outcome of major trauma and efforts made to implement and expand access to services for injury survivors across trauma systems.

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Characterizing a Common Phenomenon: Why do Trauma Patients Re-present to the Emergency Department?

Chan,

Smith,

Michael

et al. 2024

Journal of Surgical Research

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Emergency department return visits and hospital admissions in trauma team assessed patients initially discharged from the emergency department: A population-based cohort study

Abstract: Our study looks at the outcomes of trauma patients discharged home from the ED. We found that nearly one in five patients returned within two weeks but that serious diagnoses or surgical interventions were very rare. Several patient characteristics predicted return visits.

Cited by 4 publications

References 27 publications

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

Health care utilization outcomes in patients with blunt chest wall trauma following discharge from the emergency department: A retrospective, observational data-linkage study

Outpatient mental health service use in major trauma survivors: A population-based cohort study from Ontario, Canada

Characterizing a Common Phenomenon: Why do Trauma Patients Re-present to the Emergency Department?

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