Ting Hway Wong1, Yu Jie Wong2, Zheng Yi Lau2, Nivedita Nadkarni3, Gek Hsiang Lim4, Dennis Chuen Chai Seow5, Marcus Eng Hock Ong6, Kelvin Bryan Tan7, Hai V Nguyen8, Chek Hooi Wong9. 1. Department of General Surgery, Singapore General Hospital, Singapore; Duke-National University of Singapore Medical School, Singapore. Electronic address: wong.ting.hway@singhealth.com.sg. 2. Policy Research and Evaluation Division, Ministry of Health, Singapore. 3. Duke-National University of Singapore Medical School, Singapore. 4. National Registry of Diseases Office, Policy, Research and Surveillance Division, Health Promotion Board, Singapore. 5. Department of Geriatric Medicine, Singapore General Hospital, Singapore. 6. Duke-National University of Singapore Medical School, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore. 7. Policy Research and Evaluation Division, Ministry of Health, Singapore; Saw Swee Hock School of Public Health, Singapore. 8. School of Pharmacy, Memorial University of Newfoundland, Canada. 9. Geriatric Education and Research Institute, Singapore; Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore.
Abstract
OBJECTIVES: Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms. DESIGN AND MEASURES: Competing risks regression (all-cause unplanned readmission or death) was performed. SETTING AND PARTICIPANTS: Data for 5671 patients from the Singapore National Trauma Registry data who were injured from 2011-2013 and aged 55 and over were matched to Ministry of Health admissions data. The registry uses standardized conversion metrics to convert patient histories to fall heights. RESULTS: Patients injured after a low fall were more likely to be readmitted to a hospital, compared to those sustaining injuries by high-velocity blunt trauma. On competing risks analysis, low fall [subdistribution hazard ratio (SHR) 1.52, 95% confidence interval (CI) 1.20-1.93, P < .01], Charlson Comorbidity Score (CCS≥3 relative to CCS = 0, SHR 1.46, 95% CI 1.04-2.04, P = .03), and Modified Frailty Index (MFI≥3 relative to MFI = 0, SHR 1.98, 95% CI 1.44-2.72, P < .001) were associated with higher risk of 30-day readmission. Rehabilitation was associated with reduced 30-day (SHR 0.64, 95% CI 0.48-0.86, P < .001) and 1-year (SHR 0.84, 95% CI 0.72-0.99, P = .04) readmission. CONCLUSIONS/IMPLICATIONS: Our study sheds light on the interpretation of trauma data in aging populations. The detailed fall height information in our registry makes it uniquely placed to facilitate understanding of the paradoxical finding that injuries sustained by low-energy falls are higher risk than those sustained by higher-velocity mechanisms. Low-fall patients should be prioritized for rehabilitation and postdischarge support. The proportion of low-fall patients in a trauma registry should be included in the factors considered for benchmarking.
OBJECTIVES: Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms. DESIGN AND MEASURES: Competing risks regression (all-cause unplanned readmission or death) was performed. SETTING AND PARTICIPANTS: Data for 5671 patients from the Singapore National Trauma Registry data who were injured from 2011-2013 and aged 55 and over were matched to Ministry of Health admissions data. The registry uses standardized conversion metrics to convert patient histories to fall heights. RESULTS:Patients injured after a low fall were more likely to be readmitted to a hospital, compared to those sustaining injuries by high-velocity blunt trauma. On competing risks analysis, low fall [subdistribution hazard ratio (SHR) 1.52, 95% confidence interval (CI) 1.20-1.93, P < .01], Charlson Comorbidity Score (CCS≥3 relative to CCS = 0, SHR 1.46, 95% CI 1.04-2.04, P = .03), and Modified Frailty Index (MFI≥3 relative to MFI = 0, SHR 1.98, 95% CI 1.44-2.72, P < .001) were associated with higher risk of 30-day readmission. Rehabilitation was associated with reduced 30-day (SHR 0.64, 95% CI 0.48-0.86, P < .001) and 1-year (SHR 0.84, 95% CI 0.72-0.99, P = .04) readmission. CONCLUSIONS/IMPLICATIONS: Our study sheds light on the interpretation of trauma data in aging populations. The detailed fall height information in our registry makes it uniquely placed to facilitate understanding of the paradoxical finding that injuries sustained by low-energy falls are higher risk than those sustained by higher-velocity mechanisms. Low-fallpatients should be prioritized for rehabilitation and postdischarge support. The proportion of low-fallpatients in a trauma registry should be included in the factors considered for benchmarking.
Authors: Aidan Lyanzhiang Tan; Yi Chiong; Nivedita Nadkarni; Jolene Yu Xuan Cheng; Ming Terk Chiu; Ting Hway Wong Journal: World J Emerg Surg Date: 2018-12-03 Impact factor: 5.469
Authors: Ting-Hway Wong; Timothy Xin Zhong Tan; Lynette Ma Loo; Wei Chong Chua; Philip Tsau Choong Iau; Arron Seng Hock Ang; Jerry Tiong Thye Goo; Kim Chai Chan; Hai V Nguyen; Nivedita V Nadkarni; David Bruce Matchar; Dennis Chuen Chai Seow; Yee Sien Ng; Angelique Chan; Stephanie Fook-Chong; Tjun Yip Tang; Marcus Eng Hock Ong; Rahul Malhotra Journal: PLoS One Date: 2022-10-10 Impact factor: 3.752