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Traumatic Brain Injury After Falls: The Effect of Trauma Service Involvement on Syncope Workup and 30-Day Readmissions FREE TO VIEW

Amy Pate, MD; Krishna Akella; Sraavya Undurty; Akella Chendrasekhar, MD
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Richmond University Medical Center, Staten Island, NY

Chest. 2015;148(4_MeetingAbstracts):483A. doi:10.1378/chest.2281770
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: According to national estimates approximately 20% of the United States population will be aged 65 years or older by 2030. Falls are a significant cause of morbidity and morality in the elderly population. The objective of this study is to investigate the potential association between completion of syncope workup, trauma service involvement, and 30-day readmissions in patients sustaining traumatic brain injury after a fall.

METHODS: We performed a retrospective medical record review of all adult patients who sustained traumatic brain injury after a fall admitted to an urban level-I trauma center over January to June 2014. Patients were identified from the hospital registry using ICD-9 codes. Data was collected on demographics; injury severity score (ISS); trauma service involvement; loss of consciousness (LOC); length of stay (LOS); completion of syncope workup; discharge disposition; and readmission within 30 days.

RESULTS: 91 patients with a mean age of 64.9 ± 3.9 years were included. 48.4% were male. Mean LOS was 3.8 ± 0.6 days. 46.2% had positive LOC, 8.8% had no LOC, 45.1% had unknown LOC. 63 patients were admitted to a nontrauma service (NTS). 38.5% had no trauma service (TS) involvement. 49.5% received trauma consultations (TC) and 12.1% arrived as trauma team activations. 45.1% of patients had syncope workup completed. There were no mortalities. 78% of patients were discharged home; 39.6% were readmitted within 30 days of discharge. Patients admitted to TS were more likely to have completed syncope workup than those admitted to NTS (85.7% vs 27%, p<0.001). Patients who received TC were also more likely to have completed syncope workup (57.8% vs 42.2%, p<0.001). Patients who did not complete syncope workup were significantly more likely to be readmitted within 30 days of discharge (60% vs 14.6%, p<0.001). There was no significant variance in age, gender, LOS, and discharge disposition amongst patients who did and did not complete syncope workup.

CONCLUSIONS: Patients admitted to nontrauma services with traumatic brain injury after falls are significantly less likely to complete appropriate syncope workup prior to discharge. These patients are at significant risk for injury recidivism and trauma service involvement should be closely followed to prevent future potential morbidity and mortality.

CLINICAL IMPLICATIONS: Trauma service involvement in the care of patients admitted for traumatic brain injury after a fall is associated with higher rates of syncope workup completion and reduced 30-day readmissions.

DISCLOSURE: The following authors have nothing to disclose: Amy Pate, Krishna Akella, Sraavya Undurty, Akella Chendrasekhar

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