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Identifying Trauma Superutilizers Readmissions With 11-Year Data Model
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Scientific Poster Presentations: 2017 Clinical Congress
Identifying Trauma Superutilizers Readmissions With 11-Year Data Model Sean Arredondo, Mackenzie R Dome, Richard E Gilder, Jacob W Roden-Foreman, Michael L Foreman, MD, Laura B Petrey, MD, FACS Baylor University Medical Center-Dallas, Dallas, TX INTRODUCTION: Superutilizers account for a disproportionately large number of emergency department visits and hospital admissions, with increased health care costs and an increased risk for morbidity. Previous work done with 1 year of data identified factors which distinguish the superutilizer trauma patient. We aim to replicate this initial study with 11-years of data in order to better identify risk factors for trauma readmission and characteristics of superutilizers. METHODS: Data was retrospectively collected for 21,231 trauma patients admitted to a Level I ACS-certified trauma center over 11 years. Analysis of 604 patients (N¼3070 encounters), each with 3 or more readmissions, was performed to examine patterns of superutilizers. Analysis was done through binary logistic regression model. RESULTS: A total of 4459 (21%) patients were readmitted during the study period, of which 604 patients were superutilizers, accounting for 14% of the readmitting population. Superutilizer encounters ranged between 4-22, averaging 5.08 re-encounters, and a median of 4. The model identified 20 significantly independent predictors of superutilizers with a ROC curve of 0.820, characteristic of a strong model. CONCLUSIONS: Complications including comorbid disease (lymphoma, diabetes, paralysis, AIDS, solid tumor, neurological disorders, deficiency anemias, renal failure, liver disease, rheumatoid arthritis, and chronic pulmonary disease), septicemia, weight loss, and trauma recidivism distinguish the superutilizer trauma patient. Psychological comorbidities, such as depression and psychoses were also more prevalent in superutilizers. Having Medicare or Medicaid funding increased the odds of readmission by nearly 100%. Identification of population readmission factors after injury may allow for development of targeted interventions towards reducing resource utilization and healthcare cost. Impact of Time Spent in the Trauma Bay on Mortality Outcomes among Level 1 Trauma Patients Logan Adams, Jeff Dennis, PhD, Amber Tucker, Sharmila Dissanaike, MD, FACS Texas Tech University Health Sciences Center, Lubbock, TX
J Am Coll Surg
RESULTS: Charts from 1678 Level 1 trauma patients with blunt and penetrating injuries were analyzed. Of these, 345 patients died with 237 (68.7%) dying within the first 24 hours of injury. Multivariate analysis yields an inverse correlation between increased times spent in the trauma bay and mortality, with controls for injury severity, age, and race/ethnicity and with deaths in the trauma bay excluded (p<0.001). Each additional minute spent in the trauma bay increases odds of surviving by 1%. Increase in ISS and decrease in TRISS was directly correlated with reduced time in the trauma bay for both blunt and penetrating traumas. Results did not differ based on mechanism of injury or destination after the trauma bay. CONCLUSIONS: Reduced time spent in trauma bay was not correlated with improved mortality outcomes in Level 1 trauma patients. Findings do not suggest increased trauma bay time would reduce mortality, but rather current evaluation procedures may prioritize trauma patients appropriately. There is no previous literature examining trauma bay times and mortality outcomes.
Impact of Weekend Admission on Mortality and Other Outcomes among Patients with Burn Injury: A Nationwide Analysis Heather Peluso, DO, Marwan S Abougergi, MD, Julie A Caffrey, DO University of South Carolina, Greenville Health System, Greenville, SC; Johns Hopkins, Baltimore, MD INTRODUCTION: No studies have addressed the impact of day of admission on outcomes among patients with burn injuries. Our aim was to study the relationship between day of admission and important outcomes in this patient population. METHODS: Retrospective cohort study using the National Inpatient Sample. Inclusion criteria were a principal diagnosis of burn injury. Exclusion criteria were age <18 years, superficial burn, and non-urgent admission. Day of admission was divided into weekend or weekday. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock, prolonged intubation) and resource utilization (length of stay (LOS), total hospitalization costs, time to surgery and parenteral or enteral nutrition (PoEnutrition)). Confounders were adjusted for using multivariate regression analysis.
INTRODUCTION: The majority of trauma related deaths occur within the first 24 hours of injury, and time elapsed until intervention of an injury is one of the greatest causes of preventable death in trauma centers. This study seeks to determine the impact of time spent in the trauma bay on mortality outcomes.
RESULTS: This study included 20,900 patients, 29% of whom admitted on weekends. Mean age was 48.3 (47.5- 49.0) years. 32% of patients were female. Weekend mortality was higher only for patients >65 years old. Although the rates of septic shock were similar for both patient groups, weekend admission was associated with higher odds of prolonged mechanical ventilation. Surgical intervention was delayed during weekend admissions, but time to PoEnutrition was similar for both groups. Finally, LOS was longer for weekend admission, but total hospitalization charges were comparable.
METHODS: Retrospective analysis of Level 1 trauma patients from January 2010 to January 2016.
CONCLUSIONS: Day of admission is associated with increased mortality among patients with burn injury only for those >65
Scientific Poster Presentations: 2017 Clinical Congress
Identifying Trauma Superutilizers Readmissions With 11-Year Data Model Sean Arredondo, Mackenzie R Dome, Richard E Gilder, Jacob W Roden-Foreman, Michael L Foreman, MD, Laura B Petrey, MD, FACS Baylor University Medical Center-Dallas, Dallas, TX INTRODUCTION: Superutilizers account for a disproportionately large number of emergency department visits and hospital admissions, with increased health care costs and an increased risk for morbidity. Previous work done with 1 year of data identified factors which distinguish the superutilizer trauma patient. We aim to replicate this initial study with 11-years of data in order to better identify risk factors for trauma readmission and characteristics of superutilizers. METHODS: Data was retrospectively collected for 21,231 trauma patients admitted to a Level I ACS-certified trauma center over 11 years. Analysis of 604 patients (N¼3070 encounters), each with 3 or more readmissions, was performed to examine patterns of superutilizers. Analysis was done through binary logistic regression model. RESULTS: A total of 4459 (21%) patients were readmitted during the study period, of which 604 patients were superutilizers, accounting for 14% of the readmitting population. Superutilizer encounters ranged between 4-22, averaging 5.08 re-encounters, and a median of 4. The model identified 20 significantly independent predictors of superutilizers with a ROC curve of 0.820, characteristic of a strong model. CONCLUSIONS: Complications including comorbid disease (lymphoma, diabetes, paralysis, AIDS, solid tumor, neurological disorders, deficiency anemias, renal failure, liver disease, rheumatoid arthritis, and chronic pulmonary disease), septicemia, weight loss, and trauma recidivism distinguish the superutilizer trauma patient. Psychological comorbidities, such as depression and psychoses were also more prevalent in superutilizers. Having Medicare or Medicaid funding increased the odds of readmission by nearly 100%. Identification of population readmission factors after injury may allow for development of targeted interventions towards reducing resource utilization and healthcare cost. Impact of Time Spent in the Trauma Bay on Mortality Outcomes among Level 1 Trauma Patients Logan Adams, Jeff Dennis, PhD, Amber Tucker, Sharmila Dissanaike, MD, FACS Texas Tech University Health Sciences Center, Lubbock, TX
J Am Coll Surg
RESULTS: Charts from 1678 Level 1 trauma patients with blunt and penetrating injuries were analyzed. Of these, 345 patients died with 237 (68.7%) dying within the first 24 hours of injury. Multivariate analysis yields an inverse correlation between increased times spent in the trauma bay and mortality, with controls for injury severity, age, and race/ethnicity and with deaths in the trauma bay excluded (p<0.001). Each additional minute spent in the trauma bay increases odds of surviving by 1%. Increase in ISS and decrease in TRISS was directly correlated with reduced time in the trauma bay for both blunt and penetrating traumas. Results did not differ based on mechanism of injury or destination after the trauma bay. CONCLUSIONS: Reduced time spent in trauma bay was not correlated with improved mortality outcomes in Level 1 trauma patients. Findings do not suggest increased trauma bay time would reduce mortality, but rather current evaluation procedures may prioritize trauma patients appropriately. There is no previous literature examining trauma bay times and mortality outcomes.
Impact of Weekend Admission on Mortality and Other Outcomes among Patients with Burn Injury: A Nationwide Analysis Heather Peluso, DO, Marwan S Abougergi, MD, Julie A Caffrey, DO University of South Carolina, Greenville Health System, Greenville, SC; Johns Hopkins, Baltimore, MD INTRODUCTION: No studies have addressed the impact of day of admission on outcomes among patients with burn injuries. Our aim was to study the relationship between day of admission and important outcomes in this patient population. METHODS: Retrospective cohort study using the National Inpatient Sample. Inclusion criteria were a principal diagnosis of burn injury. Exclusion criteria were age <18 years, superficial burn, and non-urgent admission. Day of admission was divided into weekend or weekday. The primary outcome was inpatient mortality. Secondary outcomes were morbidity (septic shock, prolonged intubation) and resource utilization (length of stay (LOS), total hospitalization costs, time to surgery and parenteral or enteral nutrition (PoEnutrition)). Confounders were adjusted for using multivariate regression analysis.
INTRODUCTION: The majority of trauma related deaths occur within the first 24 hours of injury, and time elapsed until intervention of an injury is one of the greatest causes of preventable death in trauma centers. This study seeks to determine the impact of time spent in the trauma bay on mortality outcomes.
RESULTS: This study included 20,900 patients, 29% of whom admitted on weekends. Mean age was 48.3 (47.5- 49.0) years. 32% of patients were female. Weekend mortality was higher only for patients >65 years old. Although the rates of septic shock were similar for both patient groups, weekend admission was associated with higher odds of prolonged mechanical ventilation. Surgical intervention was delayed during weekend admissions, but time to PoEnutrition was similar for both groups. Finally, LOS was longer for weekend admission, but total hospitalization charges were comparable.
METHODS: Retrospective analysis of Level 1 trauma patients from January 2010 to January 2016.
CONCLUSIONS: Day of admission is associated with increased mortality among patients with burn injury only for those >65