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

IF 1.8 3区医学 Q2 SURGERY Journal of Surgical Research Pub Date : 2024-10-18 DOI:10.1016/j.jss.2024.09.068

Wang Pong Chan MS , Sophia M. Smith MD, MS , Cara Michael BA , Kendall Jenkins MS , Yorghos Tripodis PhD , Dane Scantling DO, MPH , Crisanto Torres MD, MPH , Sabrina E. Sanchez MD, MPH

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Abstract

Introduction

Trauma patients return to the emergency department (ED) at alarmingly high rates, despite not all patients requiring hospital resources. Reasons for ED re-presentation and associated risk factors have not been fully investigated.

Methods

Retrospective cohort study of adult trauma admissions at an urban safety net level 1 trauma center (1/12018-12/312021). Risk factors for ED re-presentation were identified using purposeful selection and modeled using multivariable logistic regression.

Results

Of 2491 patients, 19% returned within 30 d (N = 475). Most patients presented for uncontrolled pain (37%, N = 175), medical concerns (25%, N = 119), and infection (10%, N = 49). The readmission rates varied as follows: 18% for uncontrolled pain (N = 32), 42% for medical concerns (N = 50), and 67% for infection (N = 33). Risk factors for uncontrolled pain included depression/anxiety (adjusted odds ratio [aOR] 2.06, 95% confidence interval [CI] 1.39-3.05), substance use disorder (SUD) (aOR 1.65, 95% CI 1.12-2.43), and penetrating mechanism of injury (aOR 2.25, 95% CI 1.59-3.18). Risk factors for medical concerns included number of medical comorbidities (aOR 1.34, 95% CI 1.18-1.52), depression/anxiety (aOR 1.97, 95% CI 1.28-3.01), SUD (aOR 2.48, 95% CI 1.65-3.74), and nonhome discharge disposition (aOR 1.56, 95% CI 1.07-2.28). Risk factors for infection included non-English primary language (aOR 3.41, 95% CI 1.82-6.39), SUD (aOR 2.00, 95% CI 1.03-3.88), and nonhome discharge disposition (aOR 2.06, 95% CI 1.15-3.67).

Conclusions

Uncontrolled pain was the most common reason for re-presentation, although only a small fraction required readmission. Patients with penetrating injury may benefit from improved pain control. Primary care provider follow-up may help mitigate risk of medical disease exacerbation, and wound care instructions for non–English speaking patients may decrease re-presentation for infection.

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描述一种常见现象：创伤患者为何再次到急诊科就诊？

导言：尽管并非所有患者都需要医院资源，但创伤患者重返急诊科（ED）的比例却高得惊人。急诊科再次就诊的原因及相关风险因素尚未得到充分调查：方法：对城市安全网一级创伤中心收治的成人创伤患者进行回顾性队列研究（1/12018-12/312021）。通过有目的的选择确定了急诊室再次就诊的风险因素，并使用多变量逻辑回归建立了模型：结果：在 2491 名患者中，19% 的患者在 30 天内再次就诊（N = 475）。大多数患者因疼痛无法控制（37%，175 人）、医疗问题（25%，119 人）和感染（10%，49 人）而再次就诊。再入院率变化如下疼痛失控率为 18%（32 人），医疗问题率为 42%（50 人），感染率为 67%（33 人）。疼痛无法控制的风险因素包括抑郁/焦虑（调整后比值比 [aOR]2.06，95% 置信区间 [CI]1.39-3.05）、药物使用障碍 (SUD)（aOR 1.65，95% CI 1.12-2.43）和穿透性损伤（aOR 2.25，95% CI 1.59-3.18）。医疗问题的风险因素包括合并症数量（aOR 1.34，95% CI 1.18-1.52）、抑郁/焦虑（aOR 1.97，95% CI 1.28-3.01）、SUD（aOR 2.48，95% CI 1.65-3.74）和非家庭出院处置（aOR 1.56，95% CI 1.07-2.28）。感染的风险因素包括非英语母语（aOR 3.41，95% CI 1.82-6.39）、SUD（aOR 2.00，95% CI 1.03-3.88）和非家庭出院处置（aOR 2.06，95% CI 1.15-3.67）：疼痛无法控制是再次就诊的最常见原因，但只有一小部分患者需要再次入院。改善疼痛控制可使穿透伤患者受益。初级保健提供者的随访可能有助于降低内科疾病恶化的风险，对不会说英语的患者进行伤口护理指导可能会减少因感染而再次就诊的情况。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.