To investigate the effects of age and sex on 30-, 60-, and 90-day hospital readmission after acute hospital discharge for individuals with traumatic brain injury (TBI).
Retrospective cohort study.
Acute hospitals and postacute discharge settings.
Individuals (N=52,877) with Diagnosis Related Group codes of TBI, who were divided into 4 age groups: 18 to 40, 41 to 65, 66 to 75, and ≥76 years.
Main Outcome Measures
All-cause hospital readmission.
Sex differences in 30-, 60-, and 90-day hospital readmission were found among all age groups (P<.05 for all). The largest sex differences in hospital readmission were in the 2 oldest groups (66–75 and ≥76y). For both sexes, the oldest group (≥76y) had the highest adjusted 90-day readmission risk (eg, 90-d readmission: odds ratio, 2.32 [95% confidence interval, 2.01–2.69] for men; odds ratio, 1.96 [95% confidence interval, 1.59–2.43] for women). Among those readmitted within 90 days, the youngest group (18–40y) had the highest cumulative readmission percentage (35% for both sexes) within the first week of hospital discharge.
Age and sex were significantly associated with hospital readmission during the first 90 days postdischarge in our TBI sample. Specifically, those aged 66 to 75 or ≥76 years had the highest readmission risk over 90 days for both sexes. The findings suggest that clinicians should consider age and sex in discharge planning and for the entire episode of care for the population with TBI.
List of abbreviations:DRG (Diagnosis Related Group), HCUP (Healthcare Cost and Utilization Project), ICF (intermediate care facility), NRD (Nationwide Readmissions Database), OR (odds ratio), SNF (skilled nursing facility), TBI (traumatic brain injury)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The costs of traumatic brain injury: a literature review.Clinicoecon Outcomes Res. 2013; 5: 281-287
- The impact of traumatic brain injuries: a global perspective.NeuroRehabilitation. 2007; 22: 341-353
- Traumatic brain injury: a disease process, not an event.J Neurotrauma. 2010; 27: 1529-1540
- Chronic neurodegenerative consequences of traumatic brain injury.Restor Neurol Neurosci. 2014; 32: 337-365
- Chronic impact of traumatic brain injury on outcome and quality of life: a narrative review.Crit Care. 2016; 20: 148
- Report to Congress: traumatic brain injury in the United States: epidemiology and rehabilitation.(Available at:)http://www.cdc.gov/traumaticbraininjury/pdf/TBI_Report_to_Congress_Epi_and_Rehab-a.pdfDate accessed: August 24, 2015
- Trends in traumatic brain injury in the U.S. and the public health response: 1995-2009.J Safety Res. 2012; 43: 299-307
- Readmission to the acute care unit and functional outcomes in patients with severe brain injury during rehabilitation.Eur J Phys Rehabil Med. 2017; 53: 268-276
- Functional improvement in severe head injury after readmission for rehabilitation.Brain Inj. 1992; 6: 363-372
- Thinking Outside the Pillbox: Improving medication adherence and reducing readmissions. A NEHI Issue Brief.(October 2012. Available at:)http://www.nacds.org/pdfs/pr/2012/nehi-readmissions.pdfDate accessed: August 9, 2016
- Rehospitalizations among patients in the Medicare fee-for-service program.N Engl J Med. 2009; 360: 1418-1428
- Discharge against medical advice in traumatic brain injury: follow-up and readmission rate.Can J Neurol Sci. 2016; 26: 1-7
- Whatever happens to trauma patients who leave against medical advice?.Am J Surg. 2016; 211: 677-683
- US population estimates of health and social outcomes 5 years after rehabilitation for traumatic brain injury.J Head Trauma Rehabil. 2014; 29: e1-e9
- Functional status predicts acute care readmissions from inpatient rehabilitation in the stroke population.PLoS One. 2015; 10: e0142180
- Gender-specific issues in traumatic injury and resuscitation: consensus-based recommendations for future research.Acad Emerg Med. 2014; 21: 1386-1394
- Traumatic brain injury in older adults: epidemiology, outcomes, and future implications.J Am Geriatr Soc. 2006; 54: 1590-1595
- Multi-disciplinary rehabilitation for acquired brain injury in adults of working age.Cochrane Database Syst Rev. 2015; : CD004170
- Rehospitalization after traumatic brain injury: a population-based study.Arch Phys Med Rehabil. 2016; 97: S19-S25
- Overview of the Nationwide Readmissions Database (NRD).(Available at:)https://www.hcup-us.ahrq.gov/nrdoverview.jspDate accessed: December 15, 2016
- All-cause readmissions following hospital stays for patients with malnutrition: Statistical Brief #218. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.Agency for Healthcare Research and Quality, Rockville2006–2016
- Traumatic brain injury in the United States: emergency department visits, hospitalizations, and deaths.National Center for Injury Prevention and Control, Atlanta2004
- All Patient Refined Diagnosis Related Groups (APR-DRGs), Version 20.0: methodology overview.3M Health Information Systems, Wallingford2003 (Available at:)https://www.hcup-us.ahrq.gov/db/nation/nis/APR-DRGsV20MethodologyOverviewandBibliography.pdfDate accessed: November 12, 2016
- Comorbidity measures for use with administrative data.Med Care. 1998; 36: 8-27
- The revolving door: a report on US hospital readmissions.Robert Wood Johnson Foundation, Princeton2013
- Interventions to reduce 30-day rehospitalization: a systematic review.Ann Intern Med. 2011; 155: 520-528
- Early interventions for mild traumatic brain injury: reflections on experience.BCMJ. 2006; 48: 442-446
- Preventing suicide after traumatic brain injury: implications for general practice.Med J Aust. 2007; 187: 229-232
- Readmission to an acute care hospital during inpatient rehabilitation for traumatic brain injury.Arch Phys Med Rehabil. 2015; 96: S293-S303.e1
- Depression among older adults after traumatic brain injury: a national analysis.Am J Geriatr Psychiatry. 2015; 23: 607-614
- Hospital type and patient outcomes: an empirical examination using AMI readmission and mortality records.Health Econ. 2009; 18: 1440-1460
Published online: January 04, 2018
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. 90AR5009) and by the National Center for Medical Rehabilitation Research, National Institutes of Health (grant nos. P2C HD065702, R01HD069443, and K01HD086290).
© 2018 by the American Congress of Rehabilitation Medicine