title: What are we missing: results of a 13-month active follow-up program at a level I trauma center.
abstract: BACKGROUND
  Poor follow-up by patients with trauma results in a lack of knowledge of postdischarge health-related issues. This study reports on postdischarge health-related issues discovered by a program of active postdischarge contact or follow-up.
  
  
  METHODS
  All patients discharged home from the trauma service were followed up in the following manner: within 4 weeks of discharge, telephonic follow-up was attempted three times followed by scanning of electronic records. Failing that, other physicians (specialists or primary care) were contacted. Once contact was established, the patient, family member, or physician was questioned about the general well-being, any specific health-related issue, and the resolution.
  
  
  RESULTS
  During the 13-month study period ending September 2007, a total of 1,353 patients met entry criteria. Contact was established with 692 (51%). Of these, 116 (17%) were found to have significant health issues: (1) severe uncontrolled pain, 45; (2) missed injury, 17 (spine fractures, 4; clavicle or hand or foot fractures, 6; facial bone fractures, 3; soft tissue, 3; hematuria, 1); (3) wound infections, 17; (4) other infections, 17 (urinary, 8; pulmonary, 7; blood stream, 2) (5) venous thromboembolism, 10; and (6) other, 9 (psychiatric, 6; nontraumatic, 3). One patient died at home within 24 hours of discharge. The issues were significant enough for the patients to seek medical care (outpatient, 39; emergency department visits, 52; hospitalization, 24).
  
  
  CONCLUSIONS
  A significant proportion of patients with trauma have moderate to severe health-related issues postdischarge that are often not found by the trauma team or the trauma registry. Active follow-up can identify the nature of the medical issues and help in designing system changes to reduce or eliminate them.
authors.affiliation: Virginia Commonwealth University Medical Center, Richmond, Virginia, USA. akmalhot@vcu.edu
authors.forename: Ajai K
authors.initials: AK
authors.lastname: Malhotra
authors.forename: Nancy
authors.initials: N
authors.lastname: Martin
authors.forename: Melanie
authors.initials: M
authors.lastname: Jacoby
authors.forename: Janie
authors.initials: J
authors.lastname: Tarrant
authors.forename: Kelly
authors.initials: K
authors.lastname: Guilford
authors.forename: Luke G
authors.initials: LG
authors.lastname: Wolfe
authors.forename: Michel B
authors.initials: MB
authors.lastname: Aboutanos
authors.forename: Therese M
authors.initials: TM
authors.lastname: Duane
authors.forename: Rao R
authors.initials: RR
authors.lastname: Ivatury
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy