title: Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center: Statewide assessment using the Comprehensive Hospital Abstract Reporting System.
abstract: BACKGROUND
  One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for American Association for the Surgery of Trauma (AAST) Grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS).
  
  
  METHODS
  We evaluated all patients with AAST Grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998 and 2010, the only Level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury. Data were abstracted from the CHARS database for readmissions to any Washington state hospital within 6 months of renal injury. Clinical variables, diagnoses, and procedures were queried based on DRG International Classification of Diseases-9th Rev. codes.
  
  
  RESULTS
  A total of 477 Grade 3 and 159 Grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75 (16%) of 477 Grade 3 and 36 (23%) of 159 Grade 4 injuries. Within 6 months of index hospitalization, 86 (18%) of 477 Grade 3 and 38 (24%) of 159 Grade 4 patients were readmitted to any Washington state hospital. Eighty percent of Grade 3 injuries and 66% of Grade 4 injuries returned to HMC compared with secondary hospitals (p = 0.08). At readmission, 19 (22%) of 86 Grade 3 and 16 (42%) of 38 Grade 4 injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6 (7%) of 86 Grade 3 and 5 (13%) of 38 Grade 4 renal injuries (all CSL injuries).
  
  
  CONCLUSIONS
  A subset of patients treated for Grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with Grade 4 CSL injuries seem to be at the highest risk for readmission and to require a subsequent urologic procedure.
  
  
  METHODS
  Prognostic/epidemiologic study, level III.
authors.affiliation: From the Department of Urology (B.W., H.W., B.B.V.), University of Washington School of Medicine; and Harborview Injury Prevention and Research Center (H.W., B.B.V.), Seattle, Washington.
authors.forename: Brian
authors.initials: B
authors.lastname: Winters
authors.forename: Hunter
authors.initials: H
authors.lastname: Wessells
authors.forename: Bryan B
authors.initials: BB
authors.lastname: Voelzke
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006751:Hospital Information Systems; D006801:Humans; D015994:Incidence; D007668:Kidney / Q000293:injuries* / Q000601:surgery; D008297:Male; D010359:Patient Readmission / Q000639:trends*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014193:Trauma Centers; D015599:Trauma Severity Indices; D014861:Washington / Q000453:epidemiology