Firearm injury survival is only the beginning: The impact of socioeconomic factors on unplanned readmission after injury

• Published in: Injury Vol. 54; no. 8; p. 110893
• Main Authors: Lumbard, Derek C, Richardson, Chad J, Endorf, Frederick W, Nygaard, Rachel M
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.08.2023
• Subjects: Assault; Databases, Factual; Firearm Injury; Firearms; Humans; Patient Readmission; Retrospective Studies; Risk Factors; Socioeconomic Factors; Trauma; United States - epidemiology; Unplanned Readmission; Wounds, Gunshot - epidemiology; United States; Assault; Unplanned Readmission; Trauma; Firearm Injury
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2023.110893

•Approximately 10% of firearm survivors will have an unplanned readmission to the hospital within 90 days of hospital discharge.•Socioeconomic factors such as low income and urban housing are independent predictors for unplanned readmission after firearm injury.•Survivors of firearm injury discharging against medical advice were significantly more likely to be readmitted within 90 days. Firearm trauma remain a national crisis disproportionally impacting minority populations in the United States. Risk factors leading to unplanned readmission after firearm injury remain unclear. We hypothesized that socioeconomic factors have a major impact on unplanned readmission following assault-related firearm injury. The 2016–2019 Nationwide Readmission Database of the Healthcare Cost and Utilization Project was used to identify hospital admissions in those aged >14 years with assault-related firearm injury. Multivariable analysis assessed factors associated with unplanned 90-day readmission. Over 4 years, 20,666 assault-related firearm injury admissions were identified that resulted in 2,033 injuries with subsequent 90-day unplanned readmission. Those with readmissions tended to be older (31.9 vs 30.3 years), had a drug or alcohol diagnosis at primary hospitalization (27.1% vs 24.1%), and had longer hospital stays at primary hospitalization (15.5 vs 8.1 days) [all P<0.05]. The mortality rate in the primary hospitalization was 4.5%. Primary readmission diagnoses included: complications (29.6%), infection (14.5%), mental health (4.4%), trauma (15.6%), and chronic disease (30.6%). Over half of the patients readmitted with a trauma diagnosis were coded as new trauma encounters. 10.3% of readmission diagnoses included an additional ‘initial’ firearm injury diagnosis. Independent predictors of 90-day unplanned readmission were public insurance (aOR 1.21, P = 0.008), lowest income quartile (aOR 1.23, P = 0.048), living in a larger urban region (aOR 1.49, P = 0.01), discharge requiring additional care (aOR 1.61, P < 0.001), and discharge against medical advice (aOR 2.39, P < 0.001). Here we present socioeconomic risk factors for unplanned readmission after assault-related firearm injury. Better understanding of this population can lead to improved outcomes, decreased readmissions, and decreased financial burden on hospitals and patients. Hospital-based violence intervention programs may use this to target mitigating intervention programs in this population.