Factors associated with hospital admission after an emergency department treat and release visit for older adults with injuries

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Abstract

Introduction:

Emergency Department (ED) visits for injury often precede hospital admissions in older adults, but risk factors for these admissions are poorly characterized. We sought to determine the incidence and risk factors for hospitalization shortly following discharge home from an ED visit for traumatic injury in older adults. We hypothesized higher risk for admission in those with increased age, discharged home after falls, with increased comorbidity burden, and who live in poor neighborhoods.

Methods:

We identified all community-dwelling patients ≥ 65 years old treated and released for traumatic injury at non-federal EDs in Florida using the 2011 State Inpatient Database and State ED Database of the Agency for Healthcare Research and Quality. Outcome measures were hospitalization within 9 and 30 days of discharge from the ED. Multivariable logistic regression was used to establish independent risk factors for hospital admission.

Results:

Of 163,851 index ED injury visits, 6298 (3.8%) resulted in inpatient admissions within 9 days and 12,938 (7.9%) within 30 days. Factors associated with increased odds of admission within 9 days included: each additional comorbidity, ≥ moderate injury to abdomen or pelvis/extremities, and median neighborhood income < $39,000. Additional factors associated with increased odds of admission within 30 days included: lack of private insurance supplement and median neighborhood income < $48,000.

Conclusion:

Among older adults treated and discharged from the ED for an injury, those who have high comorbidity burdens, have abdominal or orthopedic injuries, and live in poor neighborhoods are at increased risk of hospitalization within 9 or 30 days of ED discharge.

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