Readmission Following Hospitalization for Traumatic Brain Injury: A Nationwide Study.

OBJECTIVE: To determine whether sociodemographic and clinical factors were associated with nonelective readmission within 30 days of hospitalization for traumatic brain injury (TBI). Secondary objectives were to examine the effects of TBI severity on readmission and characterize primary reasons for readmission. SETTING: Hospitalized patients in the United States, using the 2014 Nationwide Readmission Database. PARTICIPANTS: All patients hospitalized with a primary diagnosis of TBI between January 1, 2014, and November 30, 2014. We excluded patients (1) with a missing or invalid length of stay or admission date, (2) who were nonresidents, and 3) who died during their index hospitalization. DESIGN: Observational study; cohort study. MAIN MEASURES: Survey weighting was used to compute national estimates of TBI hospitalization and nonelective 30-day readmission. Associations between sociodemographic and clinical factors with readmission were assessed using unconditional logistic regression with and without adjustment for suspected confounders. RESULTS: There were 135 542 individuals who were hospitalized for TBI; 8.9% of patients were readmitted within 30 days of discharge. Age (strongest association for 65-74 years vs 18-24 years: adjusted odds ratio [AOR], 2.57; 95% CI: 2.02-3.27), documentation of a fall (AOR, 1.24; 95% CI: 1.13-1.35), and intentional self-injury (AOR, 3.13; 95% CI: 1.88-5.21) at the index admission were positively associated with readmission. Conversely, history of a motor vehicle (AOR, 0.69; 95% CI: 0.62-0.78) or cycling (AOR, 0.56; 95% CI: 0.40-0.77) accident was negatively associated with readmission. Females were also less likely to be readmitted following hospitalization for a TBI (AOR, 0.87; 95% CI: 0.82-0.92). CONCLUSIONS: Many sociodemographic and clinical factors were found to be associated with acute readmission following hospitalizations for TBI. Future studies are needed to determine the extent to which readmissions following TBI hospitalizations are preventable.

A quasi-experimental examination of weight-reducing dehydration practices in collegiate male rowers.

BACKGROUND: Lightweight rowers commonly utilize weight loss techniques over 24-h before competition to achieve the qualifying weight for racing. The objective was to investigate, using a quasi-experimental design, whether changes in weight resulting from dehydration practices are related to changes in proxies of bodily systems involved in rowing and whether these relationships depend on the dehydration technique used. METHODS: Twelve elite male rowers performed a power test, an incremental VO2max test, and a visuomotor battery following: weight loss via thermal exposure, weight loss via fluid abstinence and then thermal exposure, and no weight loss. The total percent body mass change (%BMC), %BMC attributable to thermal exposure, and %BMC attributable to fluid abstinence were used to predict performance variables. RESULTS: Fluid abstinence but not thermal exposure was related to a lower total wattage produced on a incremental VO2max test (b = 4261.51 W/1%BMC, 95%CI = 1502.68-7020.34), lower wattages required to elicit 2 mmol/L (b = 27.84 W/1%BMC, 95%CI = 14.69-40.99) and 4 mmol/L blood lactate (b = 20.45 W/1%BMC, 95%CI = 8.91-31.99), and slower movement time on a visuomotor task (b = -38.06 ms/1%BMC, 95%CI = -62.09--14.03). CONCLUSIONS: Dehydration related weight changes are associated with reductions in some proxies of bodily systems involved in rowing but depend on the dehydration technique used.