Emergency department visit patterns in the recently discharged, violently injured patient: Retrospective cohort review.

BACKGROUND: Analysis of the costs associated with emergency department (ED) visits after discharge for violent injury could highlight subgroups for the development of cost-effective interventions to support healing and prevent treatment failures in violently injured patients. METHODS: A retrospective cohort review was conducted of all patients with return ED visits within 90 days of discharge after treatment for a violent injury occurring between July 1, 2016, and June 30, 2018. Hospital costs were calculated for each incidence and analyzed against demographic and injury type variables to identify trends. RESULTS: 218 return ED visits were identified. Hospital costs showed a high frequency of low-cost visits. For more complex visits, distinct cost patterns were observed for Black and LatinX males compared to White males as a function of age. CONCLUSIONS: Analysis of hospital cost per visit identified trends among different subgroups. Underlying etiologies presumably vary between groups, but hypothesis-driven further investigation and needs assessment is required. Understanding the driving forces behind these cost trends may aid in developing effective interventions.

Associations between home injury falls and prior hospitalizations in community dwelling older adults: A population case-crossover study.

OBJECTIVE: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. METHODS: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360-271 days prior to index fall as reference. RESULTS: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15-2.27) during the 90 days immediately preceding the index injury fall than 181-360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51-2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94-2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. CONCLUSIONS: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.

Dissemination of a Child Passenger Safety Program Through Trauma Center-Community Partnerships.

Improper child passenger restraint use contributes to higher pediatric motor vehicle collision morbidity and mortality among cultural minority populations. Child passenger safety education improves caregiver knowledge of restraint use, but effective interventions require culturally specific programming. The purpose of this study was to evaluate the effectiveness of a child passenger safety education program culturally adapted through a pediatric trauma center's community partnerships. A nonexperimental observational cohort study using program evaluation data for the child passenger safety education programs during a 24-month period. Paired pretest/posttest self-reported survey responses measured changes in caregiver knowledge and self-efficacy of restraint use. Data were analyzed by class location and by caregiver language using a paired t test and Wilcoxon's signed ranks test. A total of 1,795 paired survey responses were collected in English, Spanish, or Russian. An increase in mean knowledge scores occurred overall, with a difference in mean of 0.565 (SE = 0.022, 95% CI [0.521, 0.607]). Stratification by class site and by language reflected significant increases in median scores, but findings were variable by study group. Pretest median scores for self-efficacy of restraint use were high for all groups, but the increases in posttest medians were also significant across groups (p ≤ .001). Caregiver knowledge and self-efficacy for child passenger restraint use increased after participation in the community classes. The pediatric trauma center's community partnerships facilitated uptake and adaption of the child passenger safety education programs and increased the injury prevention outreach to minority communities.