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Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study

Ceri Battle, Hayley Hutchings Orcid Logo, Jim Rafferty Orcid Logo, Hannah Toghill, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo

Journal of Trauma and Acute Care Surgery

Swansea University Authors: Ceri Battle, Hayley Hutchings Orcid Logo, Jim Rafferty Orcid Logo, Ashley Akbari Orcid Logo, Alan Watkins Orcid Logo

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DOI (Published version): 10.1097/ta.0000000000004086

Abstract

Background : Whilst much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the health...

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Published in: Journal of Trauma and Acute Care Surgery
ISSN: 2163-0755 2163-0763
Published: Ovid Technologies (Wolters Kluwer Health) 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa64513
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The aim of this study was to investigate the healthcare utilisation outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the UK. Methods : This was a longitudinal, retrospective, single-centre, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage (SAIL) databank for admissions to a trauma unit in the Wales, between 1st January 2016 and 31st December 2020. All patients aged ≥16 years with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data was analysed using a negative binomial regression model. Results : 3205 presentations to the ED were included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0-3 rib fractures. 4% of the cohort were reported to have COPD, and 4% using pre-injury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period post-injury, compared with the 12-week period pre-injury (OR: 1.63 95% CI: 1.33-1.99, p &lt; 0.001; OR: 1.28, 95% CI: 1.14-1.43, p &lt; 0.001; OR: 1.02. 95% CI: 1.01-1.02, p &lt; 0.001 respectively). Risk of healthcare resource utilisation increased significantly with each additional year of age, COPD and pre-injury anti-coagulant use (all p &lt; 0.05). Social deprivation and number of rib fracture did not impact outcomes. Conclusion : The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital.</abstract><type>Journal Article</type><journal>Journal of Trauma and Acute Care Surgery</journal><volume/><journalNumber/><paginationStart/><paginationEnd/><publisher>Ovid Technologies (Wolters Kluwer Health)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2163-0755</issnPrint><issnElectronic>2163-0763</issnElectronic><keywords>Rib fractures, Outcomes, Data linkage</keywords><publishedDay>30</publishedDay><publishedMonth>8</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-08-30</publishedDate><doi>10.1097/ta.0000000000004086</doi><url>http://dx.doi.org/10.1097/ta.0000000000004086</url><notes/><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This study was funded as part of a Health Research Fellowship Awarded to Ceri Battle by Health and Care Research Wales, on behalf of Welsh Government.</funders><projectreference/><lastEdited>2024-02-01T15:47:26.0906992</lastEdited><Created>2023-09-12T16:31:43.0430634</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Ceri</firstname><surname>Battle</surname><order>1</order></author><author><firstname>Hayley</firstname><surname>Hutchings</surname><orcid>0000-0003-4155-1741</orcid><order>2</order></author><author><firstname>Jim</firstname><surname>Rafferty</surname><orcid>0000-0002-1667-7265</orcid><order>3</order></author><author><firstname>Hannah</firstname><surname>Toghill</surname><order>4</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>5</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>6</order></author></authors><documents><document><filename>Under embargo</filename><originalFilename>Under embargo</originalFilename><uploaded>2023-09-12T16:35:14.2959881</uploaded><type>Output</type><contentLength>2166659</contentLength><contentType>application/pdf</contentType><version>Accepted Manuscript</version><cronfaStatus>true</cronfaStatus><embargoDate>2024-05-30T00:00:00.0000000</embargoDate><copyrightCorrect>true</copyrightCorrect><language>eng</language></document></documents><OutputDurs/></rfc1807>
spelling v2 64513 2023-09-12 Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study 9ae21f1afb903db3c39684cd47b94760 Ceri Battle Ceri Battle true false bdf5d5f154d339dd92bb25884b7c3652 0000-0003-4155-1741 Hayley Hutchings Hayley Hutchings true false 52effe759a718bd36eb12cdd10fe1a09 0000-0002-1667-7265 Jim Rafferty Jim Rafferty true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 2023-09-12 FGMHL Background : Whilst much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the healthcare utilisation outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the UK. Methods : This was a longitudinal, retrospective, single-centre, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage (SAIL) databank for admissions to a trauma unit in the Wales, between 1st January 2016 and 31st December 2020. All patients aged ≥16 years with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data was analysed using a negative binomial regression model. Results : 3205 presentations to the ED were included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0-3 rib fractures. 4% of the cohort were reported to have COPD, and 4% using pre-injury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period post-injury, compared with the 12-week period pre-injury (OR: 1.63 95% CI: 1.33-1.99, p < 0.001; OR: 1.28, 95% CI: 1.14-1.43, p < 0.001; OR: 1.02. 95% CI: 1.01-1.02, p < 0.001 respectively). Risk of healthcare resource utilisation increased significantly with each additional year of age, COPD and pre-injury anti-coagulant use (all p < 0.05). Social deprivation and number of rib fracture did not impact outcomes. Conclusion : The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital. Journal Article Journal of Trauma and Acute Care Surgery Ovid Technologies (Wolters Kluwer Health) 2163-0755 2163-0763 Rib fractures, Outcomes, Data linkage 30 8 2023 2023-08-30 10.1097/ta.0000000000004086 http://dx.doi.org/10.1097/ta.0000000000004086 COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University This study was funded as part of a Health Research Fellowship Awarded to Ceri Battle by Health and Care Research Wales, on behalf of Welsh Government. 2024-02-01T15:47:26.0906992 2023-09-12T16:31:43.0430634 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Ceri Battle 1 Hayley Hutchings 0000-0003-4155-1741 2 Jim Rafferty 0000-0002-1667-7265 3 Hannah Toghill 4 Ashley Akbari 0000-0003-0814-0801 5 Alan Watkins 0000-0003-3804-1943 6 Under embargo Under embargo 2023-09-12T16:35:14.2959881 Output 2166659 application/pdf Accepted Manuscript true 2024-05-30T00:00:00.0000000 true eng
title Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
spellingShingle Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
Ceri Battle
Hayley Hutchings
Jim Rafferty
Ashley Akbari
Alan Watkins
title_short Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
title_full Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
title_fullStr Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
title_full_unstemmed Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
title_sort Healthcare utilisation outcomes in patients with blunt chest wall trauma following discharge from the Emergency Department: a retrospective, observational data-linkage study
author_id_str_mv 9ae21f1afb903db3c39684cd47b94760
bdf5d5f154d339dd92bb25884b7c3652
52effe759a718bd36eb12cdd10fe1a09
aa1b025ec0243f708bb5eb0a93d6fb52
81fc05c9333d9df41b041157437bcc2f
author_id_fullname_str_mv 9ae21f1afb903db3c39684cd47b94760_***_Ceri Battle
bdf5d5f154d339dd92bb25884b7c3652_***_Hayley Hutchings
52effe759a718bd36eb12cdd10fe1a09_***_Jim Rafferty
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
author Ceri Battle
Hayley Hutchings
Jim Rafferty
Ashley Akbari
Alan Watkins
author2 Ceri Battle
Hayley Hutchings
Jim Rafferty
Hannah Toghill
Ashley Akbari
Alan Watkins
format Journal article
container_title Journal of Trauma and Acute Care Surgery
publishDate 2023
institution Swansea University
issn 2163-0755
2163-0763
doi_str_mv 10.1097/ta.0000000000004086
publisher Ovid Technologies (Wolters Kluwer Health)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
url http://dx.doi.org/10.1097/ta.0000000000004086
document_store_str 0
active_str 0
description Background : Whilst much is published reporting clinical outcomes in the patients with blunt chest wall trauma who are admitted to hospital from the ED, less is known about the patients’ recovery when they are discharged directly without admission. The aim of this study was to investigate the healthcare utilisation outcomes in adult patients with blunt chest wall trauma, discharged directly from ED in a trauma unit in the UK. Methods : This was a longitudinal, retrospective, single-centre, observational study incorporating analysis of linked datasets, using the Secure Anonymised Information Linkage (SAIL) databank for admissions to a trauma unit in the Wales, between 1st January 2016 and 31st December 2020. All patients aged ≥16 years with a primary diagnosis of blunt chest wall trauma discharged directly home were included. Data was analysed using a negative binomial regression model. Results : 3205 presentations to the ED were included. Mean age was 53 years, 57% were male, with the predominant injury mechanism being a low velocity fall (50%). 93% of the cohort sustained between 0-3 rib fractures. 4% of the cohort were reported to have COPD, and 4% using pre-injury anticoagulants. On regression analysis, inpatient admissions, outpatient appointments and primary care contacts all significantly increased in the 12-week period post-injury, compared with the 12-week period pre-injury (OR: 1.63 95% CI: 1.33-1.99, p < 0.001; OR: 1.28, 95% CI: 1.14-1.43, p < 0.001; OR: 1.02. 95% CI: 1.01-1.02, p < 0.001 respectively). Risk of healthcare resource utilisation increased significantly with each additional year of age, COPD and pre-injury anti-coagulant use (all p < 0.05). Social deprivation and number of rib fracture did not impact outcomes. Conclusion : The results of this study demonstrate the need for appropriate signposting and follow-up for patients with blunt chest wall trauma presenting to the ED, not requiring admission to the hospital.
published_date 2023-08-30T15:47:26Z
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