Hospital readmission after blunt traumatic rib fractures

Abstract

BACKGROUND:Hospital readmissions are resource intensive, associated with increased morbidity, and often used as hospital-level quality indicators. The factors that determine hospital readmission after blunt thoracic trauma have not been sufficiently defined. We sought to identify predictors of hospital readmission in patients with traumatic rib fractures. METHODS:We performed an 8-year (2011-2019) retrospective chart review of patients with traumatic rib fractures who required unplanned readmission within 30 days of discharge at a Level 1 trauma center. Patient characteristics, injury severity, and hospital complications were examined using quantitative analysis to identify readmission risk factors. RESULTS:There were 13,046 trauma admissions during the study period. The traumatic rib fracture cohort consisted of 3,720 patients. The cohort included 206 patients who were readmitted within 30 days of discharge. The mean age of the traumatic rib fracture cohort was 57 years, with a 6-day median length of stay. The 30-day mortality rate was 5%. Use of anticoagulation (11.0 vs. 5.4; p = 0.029), diagnosis of a psychiatric disorder (10.2 vs. 5.3; p = 0.01), active smoking (7.3 vs. 5.0; p = 0.008), associated hemothorax (8.3 vs. 5.2; p = 0.010), higher abdominal Abbreviated Injury Scale (33.3 vs. 8.4 vs. 6.5; p = 0.002), rapid response activation (8.9 vs. 5.2; p = 0.005), admission to intensive care unit (7.7 vs. 4.5; p = 0.001), and diagnosis of in-hospital pneumonia (10.1 vs. 5.4; p = 0.022) were predictors of hospital readmission. On multivariate analysis, prescribed anticoagulation (odds ratio [OR], 2.22; p = 0.033), active smoking (OR, 1.58; p = 0.004), higher abdominal Abbreviated Injury Scale (OR, 1.50; p = 0.054), and diagnosis of a psychiatric disorder (OR, 2.00; p = 0.016) predicted hospital readmission. CONCLUSION:In patients with traumatic rib fractures, those with anticoagulant use, those who actively smoke, those with a psychiatric diagnosis, or those with associated abdominal injuries are at the highest risk of rehospitalization following discharge. Quality improvement should focus on strategies and protocols directed toward these groups to reduce nonelective readmissions.

DeepBackRib: Deep learning to understand factors associated with readmissions after rib fractures

“…Shapley additive explanation analysis reaffirmed positive associations between readmissions after rib fractures and risk factors identified using traditional statistical models (e.g., older age, underlying chronic obstructive pulmonary disease, and longer index hospitalization length of stay; Supplemental Digital Content, Supplementary Table 5, http://links.lww.com/TA/ C703). [2][3][4][5]18 Some findings, such as opposite associations between readmissions and private (negative) or Medicare (positive) primary payor status, matched intuition. Others, such as the negative association between readmission and pneumothorax diagnosis during index hospitalization, highlighted opportunities for future exploratory analyses.…”

“…2,3 Several studies have evaluated factors associated with readmissions after rib fractures using traditional statistical models (e.g., logistic regression). [2][3][4][5] Although traditional models are interpretable, they are inflexible models whose generalizability depends on the variable selection technique and concordance between the estimated function and a true predictor(s)-outcome relationship. 6 In the modern era of abundant data, computational power, and efficient algorithms, deep learning has emerged as a flexible, high-performing alternative to traditional models.…”

“…Several studies have evaluated factors associated with readmissions after rib fractures using traditional statistical models (e.g., logistic regression) 2–5 . Although traditional models are interpretable, they are inflexible models whose generalizability depends on the variable selection technique and concordance between the estimated function and a true predictor(s)-outcome relationship 6 .…”

Expert consensus guidance on respiratory physiotherapy and rehabilitation of patients with rib fractures: An international, multidisciplinary e-Delphi study

“…Rib fractures account for more than 15% of all trauma admissions worldwide, with the most common injury mechanisms being low velocity falls, high velocity falls, road traffic collisions, assaults, and sporting injuries. 1 Difficulties in the management of patients with rib fractures are becoming increasingly well recognized in the literature. 2 , 3 There is limited research supporting optimal respiratory physiotherapy or physical rehabilitation strategies for patients with rib fractures, and as a result, no consensus exists for physiotherapists/physical therapists managing this patient group.…”

“…Rib fractures account for more than 15% of all trauma admissions worldwide, with the most common injury mechanisms being low velocity falls, high velocity falls, road traffic collisions, assaults, and sporting injuries 1 . Difficulties in the management of patients with rib fractures are becoming increasingly well recognized in the literature 2,3 .…”