Post-Trauma Follow-up Phone Call Shows Lower Readmission Rates for Patients Discharged From Emergency Department Compared to Inpatient Stay.

BACKGROUND: Studies show follow-up phone calls decrease readmission rates (RR) in trauma patients and social vulnerabilities may play a role as well. Minimal literature exists comparing RR of trauma patients who required an inpatient stay to those whose treatment was limited to the Emergency Department (ED), as they are at high risk of recidivism. We hypothesized post-trauma follow-up calls would show higher RR for ED patients than those requiring inpatient stay, as well as potentially differing outcomes for minorities. STUDY DESIGN: A retrospective analysis from 2019-2020 of 1328 trauma patients from UCI Medical Center, discharged from inpatient facilities or the ED. A questionnaire script read by a nurse practitioner to patients via phone call following discharge. Data associated with readmission were captured. Multivariable logistic regression analysis was performed, controlling for patient factors including severity of injury. RESULTS: Patients discharged from the ED were 47.4% less likely to be readmitted than those who required an inpatient stay (P < .01). However, ED patients were 88.7% less likely to receive a prescription than inpatient stay patients (P < .01). No difference between ED and inpatient discharge contact rates was noted (P < .99). Furthermore, no difference in readmission rates was noted for minorities. CONCLUSION: Post-trauma follow-up calls showed lower RR for index ED visit patients than those requiring inpatient stay, contrary to expectations. However, ED visit patients were also less likely to receive/fill prescriptions compared to those requiring inpatient stay. Ongoing analysis is warranted to further validate and improve follow-up call programs to ensure equitable health care.

Risk for contrast-induced nephropathy in elderly trauma patients.

The objective of this study was to determine if elderly trauma patients are at risk for contrast-induced nephropathy (CIN). A retrospective study was conducted identifying 362 patients 65 years and older in our Level I trauma center who received computerized tomography (CT) scans with intravenous contrast. CIN was defined as a 25 per cent increase in serum creatinine levels or a 0.5 mg/dL increase above baseline after CT. History of diabetes mellitus, hospital length of stay, intensive care unit length of stay, Injury Severity Score (ISS), and age were recorded. Eighteen per cent (21 of 118) of the patients had a peak in creatinine, 12 per cent (14 of 118) peaked and returned to baseline, and 6 per cent (7 of 118) peaked and stayed high. Pre-CT elevated creatinine, diabetes mellitus, increased hospital length of stay, ISS, and age show little association to CIN. The data suggest that CIN in elderly trauma patients is rare, regardless of history of diabetes mellitus, age, creatinine, high ISS, or result in higher length of stay. Therefore, there is little justification for the delay in diagnosis to assess a patient's renal susceptibility.

Traffic law knowledge disparity between Hispanics and non-Hispanic whites in California.

BACKGROUND: The Hispanic population is one group that is involved in a disproportionately high percentage of fatal motor vehicle collisions in the United States. STUDY OBJECTIVES: This study investigated demographic factors contributing to a lack of knowledge and awareness of traffic laws among Hispanic drivers involved in motor vehicle collisions (MVCs) in southern California. METHODS: The cross-sectional study enrolled adults (n = 190) involved in MVCs presenting to a Level I trauma center in southern California over a 7-month period. Subjects completed a survey about California traffic law knowledge (TLK) consisting of eight multiple-choice questions. The mean number of questions answered correctly was compared between groups defined by demographic data. RESULTS: The mean number of TLK questions answered correctly by Hispanic and non-Hispanic white groups were significantly different at 4.13 and 4.62, respectively (p = 0.005; 95% confidence interval -0.83 to -0.15). Scores were significantly lower in subjects who were not fluent in English, had less than a high school education, did not possess a current driver's license, and received their TLK from sources other than a driver's education class or Department of Motor Vehicle materials. Analysis of variance showed that the source of knowledge was the strongest predictor of accurate TLK. CONCLUSION: Source of TLK is a major contributing factor to poor TLK in Hispanics. An emphasis on culturally specific traffic law education is needed.