title: Trauma center care is associated with reduced readmissions after injury.
abstract: BACKGROUND
  Trauma center care has been associated with improved mortality. It is not known if access to trauma center care is also associated with reduced readmissions. We hypothesized that receiving treatment at a trauma center would be associated with improved care and therefore would be associated with reduced readmission rates.
  
  
  METHODS
  We conducted a retrospective analysis of all hospital visits in California using the Office of Statewide Health Planning and Development Database from 2007 to 2008. All hospital admissions and emergency department visits associated with injury were longitudinally linked. Regions were categorized by whether they had trauma centers. We excluded all patients younger than 18 years. We performed univariate and multivariate regression analyses to determine if readmissions were associated with patient characteristics, length of stay for initial hospitalization, trauma center access, and triage patterns.
  
  
  RESULTS
  A total of 211,504 patients were included in the analysis. Of these, 5,094 (2%) died during the index hospitalization. Of those who survived their initial hospitalization, 79,123 (38%) experienced one or more readmissions to any hospital within 1 year. The majority of these were one-time readmissions (62%), but 38% experienced multiple readmissions. Over 67% of readmissions were unplanned and 8% of readmissions were for a trauma. After controlling for patient variables known to be associated with readmissions, primary triage to a trauma center was associated with a lower odds of readmission (odds ratio, 0.89; p < 0.001). The effect of transport to a trauma center remained significantly associated with decreased odds of readmission at 1 year (odds ratio, 0.96; p < 0.001).
  
  
  CONCLUSIONS
  Readmissions after injury are common and are often unscheduled. While patient factors play a role in this, care at a trauma center is also associated with decreased odds for readmission, even when controlling for severity of injury. This suggests that the benefits of trauma center care extend beyond improvements in mortality to improved long-term outcomes.
  
  
  METHODS
  Epidemiologic study, level III; therapeutic/care management study, level IV.
authors.affiliation: From the Department of Surgery (K.S., T.G.W., P.M.M., D.A.S.), Stanford University School of Medicine, Stanford; and Department of Emergency Medicine (R.Y.H.), Institute of Health Policy Studies, University of California-San Francisco, San Francisco, California.
authors.forename: Kristan
authors.initials: K
authors.lastname: Staudenmayer
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
authors.forename: Paul M
authors.initials: PM
authors.lastname: Maggio
authors.forename: David A
authors.initials: DA
authors.lastname: Spain
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014193:Trauma Centers / Q000458:organization & administration*; D014218:Triage / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D055815:Young Adult