title: Serum procalcitonin is a marker for prediction of readmission from an intermediate care to an acute care hospital in neurosurgical patients.
abstract: BACKGROUND
  Readmission of patients to acute hospitals contributes significantly toward inefficient utilization of healthcare resources, with studies quoting up to 90% being preventable. We aim to report and analyze the factors involved in the readmission of neurosurgical patients who had been previously transferred to an intermediate step-down care facility, and explore possible predictive markers for such readmissions.
  
  
  METHODS
  We conducted a retrospective analysis of all 129 neurosurgical patients who were transferred from out acute tertiary hospital to an intermediate care facility. The cases were segregated into those who were readmitted and those who were not readmitted back to our acute center. The demographic data, clinical features, diagnoses, treatment modalities, pretransfer laboratory findings, and inpatient complications were compared with readmission rate.
  
  
  RESULTS
  There were 23 patients (17.8%) who were readmitted to our acute hospital. The most common causes of readmission was infection (n = 12, 52.2%). We found a statistically significant correlation between the higher pretransfer procalcitonin levels with the readmission of our patients (P = 0.037). There was also a significant difference noted between ethnic groups (P = 0.026) and having no complications of disease or treatment (P = 0.008), with readmission.
  
  
  CONCLUSIONS
  Procalcitonin is a pro-hormone known to correlate with infection and poor neurological status. We have found that its serum values correlate significantly with the readmission rates of neurosurgical patients in our study. We postulate that by ensuring normality in procalcitonin levels prior to transfer to an intermediate care facility, potentially half of neurosurgical readmissions can be prevented.
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Jia Xu
authors.initials: JX
authors.lastname: Lim
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Nicolas
authors.initials: N
authors.lastname: King
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Sharon
authors.initials: S
authors.lastname: Low
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, Singapore.
authors.forename: Wai Hoe
authors.initials: WH
authors.lastname: Ng
keywords: Intermediate care; neurosurgery; procalcitonin; readmission