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JOURNAL ARTICLE

Factors influencing discharge location after hospitalization resulting from a traumatic fall among older persons

Hyun J Lim, Raymond Hoffmann, Karen Brasel
Journal of Trauma 2007, 63 (4): 902-7
18090024

OBJECTIVE: To identify significant demographic, clinical, and nonclinical factors among elderly persons influencing the discharge location after hospitalization resulting from a traumatic fall.

METHODS: Population-based case-only study with use of data from the 2003 National Trauma Data Bank. The study analysis included 47,234 subjects admitted to 1 of 405 hospitals in the United States between 1989 and 2003, and aged between 65 and 89 years. Demographic characteristics, clinical factors, and discharge location were obtained from the database.

RESULTS: Eighty-three percent were discharged to home, 7% to a nursing home, and 10% to a rehabilitation facility. Female patients and white patients were more likely discharged to a nursing home or a rehabilitation facility than to home. Compared with commercial insurance, a patients who had Medicare was more likely discharged to a nursing home (odds ratio = 20.9; 95% confidence interval: 18.2-23.9) or a rehabilitation facility (odds ratio = 5.39; 95% confidence interval: 4.86-5.96) than to home. A patient who was injured in the face or neck, thorax, or abdomen was less likely discharged to a nursing home or a rehabilitation facility than to home when compared with a patient injured in an upper and lower extremity. A patient with an injury to the spine was more likely discharged to a rehabilitation facility than to home when compared with a patient injured in any other body region.

CONCLUSION: Gender, race, payment type, body region injured, Injury Severity Score, physiologically based Emergency Department Revised Trauma Score, and need for intensive care unit care were significant predictors of discharge location. Understanding and addressing the factors found in this study can improve the discharge planning process and posttreatment management.

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