M. Castillo-Angeles1, T. Uribe-Leitz1, S. Nitzschke1, D. Nehra1, A. H. Haider1, A. Salim1, R. Askari1 1Brigham And Women’s Hospital,Boston, MA, USA
Introduction: Violence continues to be a significant public health burden. However, little is known about the causes and associated social and patient factors for unplanned readmissions among these trauma patients. Our goal was to determine the incidence and burden of violence-related trauma and to identify predictors of readmission.
Methods: This is a retrospective study using the Florida State Inpatient Database 2010-2014. The inclusion criteria were all patients admitted for violence-related traumatic injuries. These were classified as self-inflicted, assault (violence conducted by an unknown perpetrator) or maltreatment (acts of abuse and neglect conducted by a caregiver or intimate partner). Demographics and clinical characteristics were collected. Outcomes were 30-day readmission and in-hospital mortality. Multivariable regression models were used to identify factors associated with 30-day readmission and mortality.
Results: A total of 306,835 violence-related admissions were identified; 115,325 (37.59%) were readmitted within 30 days. The overall in-hospital mortality rate was 0.67%. Mean age was 42 years (SD 16.2), 135,610 (44.2%) were female and 67% were white. Self-inflicted violence was the most common type of admission (88.9%). After adjusted analysis, predictors of readmissions were age (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.01 – 1.02), female gender (OR 0.64, 95% CI 0.63 – 0.65), having public insurance (vs. private) (OR 2.45, 95% CI 2.40 – 2.51), being a racial minority (OR 0.85, 95% CI 0.83 – 0.86) and Charlson score (OR 1.26, 95% CI 1.25 – 1.28). Age, gender, being uninsured, black race and Charlson score were associated with increased in-hospital mortality.
Conclusion: Violence-related trauma have a high readmission rate and consequently high resource utilization. Multiple factors associated with disparities influence readmission among these violence-related trauma patients. Further work is needed to identify intervention strategies that may be beneficial to reduce readmissions after violence-related trauma.