title: Factors affecting the likelihood of presentation to the emergency department of trauma patients after discharge.
abstract: OBJECTIVE
  We determine the rate at which trauma patients re-present to the emergency department (ED) after discharge from the hospital and determine whether re-presentation is related to race, insurance, and socioeconomic factors such as neighborhood income level.
  
  
  METHODS
  Trauma patients admitted to a Level I trauma center between January 1, 1997, and December 31, 2007, were identified with the hospital's trauma registry. These patients were linked to administrative data to obtain information about re-presentation to the hospital. Neighborhood income was obtained with census block data; multiple imputation was implemented to account for missing income data. Logistic regression analysis was used to determine the predictors of re-presentation.
  
  
  RESULTS
  There were 6,675 patients who were included in the study. A total of 886 patients (13.3%) returned to the ED within 30 days of discharge from the hospital. Uninsured patients (odds ratio [OR]=1.64; 95% confidence interval [CI] 1.30 to 2.06) and publicly insured patients (OR=1.60; 95% CI 1.20 to 2.14) were more likely to re-present to the ED than those with commercial insurance. Residing in a neighborhood with a median household income less than $20,000 was associated with a higher odds of re-presentation (OR=1.77; 95% CI 1.37 to 2.29). Only 13.2% of patients who came to the ED were readmitted to the hospital.
  
  
  CONCLUSIONS
  A substantial number of trauma patients return to the ED within 30 days of being discharged, but only a small proportion of these patients required readmission. Re-presentation is associated with being uninsured or underinsured and with lower neighborhood income level.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Karim S
authors.initials: KS
authors.lastname: Ladha
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Young
authors.forename: Derek K
authors.initials: DK
authors.lastname: Ng
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: Adil H
authors.initials: AH
authors.lastname: Haider
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D007182:Income; D015601:Injury Severity Score; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D012008:Recurrence; D012959:Socioeconomic Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D055815:Young Adult