Abstract Details

Title Predictors of 30-day Readmission in Firearm-related Traumatic Brain Injury- A Nationwide Readmission Database Study

Topic Neuro Trauma and Critical Care

Presentation(s) P2 - Poster Session 2 (8:00 AM-9:00 AM)

Poster/Presentation
Number 4-002

Objective Using the Nationwide Readmission Database (NRD), this study evaluates the predictors of readmission for adult patients with firearm-related traumatic brain injuries (TBIs).

Background 30-day hospital readmissions (30dRA) are used to measure quality of care, as higher rates are associated with poor outcomes and complications. TBI readmissions disrupt postoperative care and delay recovery. The readmission rates for firearm TBIs - a high lethality injury - are unknown.

Design/Methods Firearm injury-related TBI discharges in the NRD were tracked for 30dRA between 2016 and 2021. Patients ≥18 years old with primary TBI diagnoses and co-diagnoses of firearm injury were selected using ICD-10-CM codes. Non-civilian firearm injuries, elective admissions, in-hospital deaths, no available length of stay (LOS), and out-of-state admissions were excluded. NRD discharge weights were applied. Unpaired t-tests and Rao-Scott chi-square tests adjusted for NRD discharge weights were conducted to compare demographics, hospital characteristics, procedures, comorbidities, complications, and discharge patterns in patients with and without 30dRA.

Results Our cohort comprised 3654 discharges, including 365 (10%) with corresponding readmissions. Patients with tracheostomy (p<0.01), gastrotomy (p<0.01), decompressive craniectomy (p<0.01), or other CNS drainage procedures (p=0.025) were more likely to have 30dRA. Postprocedural nervous system hemorrhage (p<0.01) and pneumonia (p<0.01) were also associated with 30dRA. Longer LOS (p=0.0131) and transfer to a short-term hospital (p<0.01) had greater probabilities of 30dRA. Routine discharge (p<0.01), as defined by the NRD (e.g. discharged to home or self-care), was associated with a decreased likelihood of 30dRA.

Conclusions More invasive procedures–often performed for the treatment of severe TBI–are associated with higher odds of 30dRA outcomes in survivors. Postprocedural neurological and respiratory complications were associated with 30dRA. Longer LOS and transfers to short-term hospitals were associated with 30dRA. These findings may reflect the severity of injury at baseline but also suggest the importance of meticulous procedural selection and discharge management.

Authors/Disclosures
Christopher Chang, BS PRESENTER	Mr. Chang has nothing to disclose.
John Lin	Mr. Lin has nothing to disclose.
Jia-Shu Chen, MD	Dr. Chen has nothing to disclose.
Joshua Feler, MD	Dr. Feler has nothing to disclose.
Belinda Shao, MD	Dr. Shao has nothing to disclose.
Diana Wang	Ms. Wang has nothing to disclose.
Kevin V. Nguyen	Mr. Nguyen has nothing to disclose.
Damian Sanchez, BS	Mr. Sanchez has nothing to disclose.
Ethan Winkler, MD, PhD	Dr. Winkler has nothing to disclose.
Megan Ranney, MD, MPH	Dr. Ranney has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for National Opioid Abatement Trust II. Dr. Ranney has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for CRICO. The institution of Dr. Ranney has received research support from NIH. The institution of Dr. Ranney has received research support from CDC. The institution of Dr. Ranney has received research support from Multiple foundations.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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