title: Emergency department recidivism in adults older than 65 years treated for fractures.
abstract: OBJECTIVE
  Fractures in older adults are a commonly diagnosed injury in the emergency department (ED). We performed a retrospective medical record review to determine the rate of return to the same ED within 72 hours (returns) and the risk factors associated with returning.
  
  
  METHODS
  A retrospective medical record review of patients at least 65 years old discharged from a large, academic ED with a new diagnosis of upper extremity, lower extremity, or rib fractures was performed. Risk factors analyzed included demographic data, type of fracture, analgesic prescriptions, assistive devices provided, other concurrent injuries, and comorbidities (Charlson Comorbidity Index). Our primary outcome was return to the ED within 72 hours.
  
  
  RESULTS
  Three hundred fifteen patients qualified. Most fractures were in the upper extremity (64% [95% confidence interval {CI}, 58%-69%]). Twenty patients (6.3% [95% CI, 3.9%-9.6%]) returned within 72 hours. Most returns (15/20, 75%) were for reasons associated with the fracture itself, such as cast problems and inadequate pain control. Only 3 (<1% of all patients) patients returned for cardiac etiologies. Patients with distal forearm fractures had higher return rates (10.7% vs 4.5%, P = .03), and most commonly returned for cast or splint problems. Age, sex, other injuries, assistive devices, and Charlson Comorbidity Index score (median, 1 [interquartile range, 1-2] for both groups) did not predict 72-hour returns.
  
  
  CONCLUSIONS
  Older adults with distal forearm fractures may have more unscheduled health care usage in the first 3 days after fracture diagnosis than older adults with other fracture types. Overall, revisits for cardiac reasons or repeat falls were rare (<1%).
authors.affiliation: Department of Emergency Medicine, The Ohio State University, Columbus, Ohio. Electronic address: LTSoutherland@gmail.com.
authors.forename: Lauren T
authors.initials: LT
authors.lastname: Southerland
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Richardson
authors.affiliation: Department of Emergency Medicine, The Ohio State University, Columbus, Ohio.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Caterino
authors.affiliation: Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Alex C
authors.initials: AC
authors.lastname: Essenmacher
authors.affiliation: Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Swor
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012307:Risk Factors