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Hospital Readmissions After Pediatric Trauma

Maddux, Aline B. MD, MSCS1,2; DeWitt, Peter E. MS3; Mourani, Peter M. MD1,2; Bennett, Tellen D. MD, MS1,2,4

Pediatric Critical Care Medicine: January 2018 - Volume 19 - Issue 1 - p e31-e40
doi: 10.1097/PCC.0000000000001383
Online Clinical Investigations
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Objectives: To determine the rate, etiology, and timing of unplanned and planned hospital readmissions and to identify risk factors for unplanned readmission in children who survive a hospitalization for trauma.

Design: Multicenter retrospective cohort study of a probabilistically linked dataset from the National Trauma Data Bank and the Pediatric Health Information System database, 2007–2012.

Setting: Twenty-nine U.S. children’s hospitals.

Patients: 51,591 children (< 18 yr at admission) who survived more than or equal to a 2-day hospitalization for trauma.

Measurements and Main Results: The primary outcome was unplanned readmission within 1 year of discharge from the injury hospitalization. Secondary outcomes included any readmission, reason for readmission, time to readmission, and number of readmissions within 1 year of discharge. The primary exposure groups were isolated traumatic brain injury, both traumatic brain injury and other injury, or nontraumatic brain injury only. We hypothesized a priori that any traumatic brain injury would be associated with both planned and unplanned hospital readmission. We used All Patient Refined Diagnosis Related Groups codes to categorize readmissions by etiology and planned or unplanned. Overall, 4,301/49,982 of the patients (8.6%) with more than or equal to 1 year of observation time were readmitted to the same hospital within 1 year. Many readmissions were unplanned: 2,704/49,982 (5.4%) experienced an unplanned readmission in the first year. The most common reason for unplanned readmission was infection (22%), primarily postoperative or posttraumatic infection (38% of readmissions for infection). Traumatic brain injury was associated with lower odds of unplanned readmission in multivariable analyses. Seizure or RBC transfusion during the index hospitalization were the strongest predictors of unplanned, earlier, and multiple readmissions.

Conclusions: Many survivors of pediatric trauma experience unplanned, and potentially preventable, hospital readmissions in the year after discharge. Identification of those at highest risk of readmission can guide targeted in-hospital or postdischarge interventions.

1Pediatric Critical Care, University of Colorado School of Medicine, Aurora, CO.

2Children’s Hospital Colorado, Aurora, CO.

3Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.

4Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, CO.

This study was performed at University of Colorado School of Medicine.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (grant K23HD074620 to Dr. Bennett).

Dr. Bennett’s institution received funding from the National Institute of Child Health and Human Development and the State of Colorado Traumatic Brain Injury Research Program, and he received support for article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: aline.maddux@childrenscolorado.org

Copyright © 2017 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies