Nationwide risk factors for hospital readmission for subsequent injury after motor vehicle crashes
Creators: name: Parreco, Joshua
name: Eidelson, Sarah A.
name: Revell, Scott
name: Zakrison, Tanya L.
name: Schulman, Carl I.
name: Rishi Rattan
Publisher: name: Taylor & Francis
Year: 2018
Subjects: subject: Biochemistry
subject: Space Science
subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: Cell Biology
subject: Neuroscience
subject: Biotechnology
subject: 39999 Chemical Sciences not elsewhere classified
subject: FOS: Chemical sciences
subject: FOS: Chemical sciences
subject: Sociology
subject: FOS: Sociology
subject: FOS: Sociology
subject: Immunology
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences

description: <b>Objective:</b> Some drivers involved in motor vehicle crashes across the United States may be identified as at risk of subsequent injury by a similar mechanism. The purpose of this study was to perform a national review of the risk factors for hospitalization for a new injury due to a subsequent motor vehicle crash. It was hypothesized that presenting to a different hospital after subsequent injury would result in worse patient outcomes when compared to presentation at the same hospital. <b>Methods:</b> The Nationwide Readmissions Database for 2010–2014 was queried for all inpatient hospitalizations with injury related to motor vehicle traffic. The primary patient outcome of interest was subsequent motor vehicle crash–related injury within 1 year. The secondary patient outcomes were different hospital subsequent injury presentation, higher Injury Severity Score (ISS), longer length of stay (LOS), and in-hospital death after subsequent injury. The analysis of secondary patient outcomes was performed only on patients who were reinjured. Univariable analysis was performed for each outcome using all variables during the index admission. Multivariable logistic regression was performed using all significant (<i>P</i> &lt; .05) variables on univariate analysis. Results were weighted for national estimates. <b>Results:</b> During the study period, 1,008,991 patients were admitted for motor vehicle–related injury; 12,474 patients (1.2%) suffered a subsequent injury within 1 year. From the reinjured patients, 32.9% presented to a different hospital, 48.9% had a higher ISS, and 22.1% had a longer LOS. The in-hospital mortality rate after subsequent injury was 1.1%. Presentation to a different hospital for subsequent injury was associated with a longer LOS (odds ratio [OR] = 1.32; 95% confidence interval [CI], 1.20–1.45; <i>P</i> &lt; .01) and a higher ISS (OR = 1.38; 95% CI, 1.27–1.49; <i>P</i> &lt; .01). Motorcyclists were more likely to suffer subsequent injury (OR = 1.39; 95% CI, 1.32–1.46; <i>P</i> &lt; .01) and motorcycle passengers were more likely to present to a different hospital with a subsequent injury (OR = 2.49; 95% CI, 1.73–3.59; <i>P</i> &lt; .01). Alcohol abuse was associated with subsequent injury (OR = 1.12; 95% CI, 1.07–1.18; <i>P</i> &lt; .01). <b>Conclusions:</b> Nearly a third of patients suffering subsequent motor vehicle crash–related injury after an initial motor vehicle crash in the United States present to a different hospital. These patients are more likely to suffer more severe injuries and longer hospitalizations due to their subsequent injury. Future efforts to prevent these injuries must consider the impact of this fragmentation of care and the implications for quality and cost improvements.