J. K. Canner1, F. Gani1, S. Selvarajah1, A. H. Haider1, E. B. Schneider1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Thirty-day readmission after discharge from inpatient care for traumatic brain injury (TBI) among patients under the age of 65 years in the United States has not been well reported. This study examined readmission to acute care in a population of patients under the age of 65, all of whom were covered by employer-provided private health insurance.
Methods: The Market Scan database from 2010 to 2012, which includes over 50 million patients under the age of 65 covered through an employer-sponsored insurance plan, was queried. Patients hospitalized with a primary diagnosis of TBI, and who had no other injury associated with an Abbreviated Injury Scale (AIS) score of 3 or greater to any other non-head body region, were identified and included for study. Patients with fewer than 30 days of follow-up were excluded. Outcomes of interest included readmission to inpatient care within 30 days of index discharge and primary diagnosis at readmission. Multivariable logistic regression, controlling for demographic, injury and hospital-level variables, examined factors associated with readmission.
Results: A total of 27,998 patients in the MarketScan database with at least one eligible TBI hospitalization met inclusion criteria. Mean (SD) patient age was 33.9 (20.2) (Figure), 65.3% were male, and 8.8% had a Charlson Comorbidity Index of 2 or greater. Mean (SD) Injury Severity Score (ISS) was 13.3 (6.7) and 73.1% had a head AIS ≥ 3. Mean (SD) length of stay was 4.4 (8.5) days. Patient disposition at discharge varied as follows: 79.3% were discharged home, 5.8% to inpatient rehabilitation, 5.1% to another facility, and 3.8% died in hospital. Of the 26,922 patients discharged alive, 1,709 (6.4%) were re-hospitalized within 30 days. Among readmitted patients, 27.8% carried a TBI-related primary diagnosis, more than half of which (56.5%) involved some form of intracranial hemorrhage. Other common primary readmission diagnoses included infection (4.0% of all readmissions), alcohol dependence (2.7%), venous thromboembolism (2.3%), and post-concussion syndrome (2.1%). Patients who were older (OR: 1.01 per additional year of age), had a head AIS of 3 or greater (OR: 1.10), had one (OR: 1.29) or more (OR: 2.04) comorbidities, or had a longer index length of stay (OR: 1.02 per additional day) demonstrated increased odds of being re-hospitalized within 30 days (all p<0.001).
Conclusion: Patients discharged from inpatient care for TBI are at risk of readmission. Further research is warranted to better understand specific factors associated with readmission and how consideration of these factors at the time of discharge planning might reduce patient readmission.
