LAUSR

Our study looks at the outcomes of trauma patients discharged home from the ED. We found that nearly one in five patients returned within two weeks but that serious diagnoses or surgical interventions were very rare. Several patient characteristics predicted return visits. BACKGROUND Many injured patients are transported directly to trauma centers, found to be minimally injured, and discharged directly home from the emergency department (ED). Our objectives were to characterize the short-term outcomes in this discharged patient population and to identify patient factors predictive of ED return visits. METHODS We conducted a retrospective population-based cohort study using linked administrative data sets involving patients assessed at trauma centers in Ontario, Canada between April 1, 2009, and March 31, 2020. Patients who were assessed by a trauma team and discharged directly home from ED were included. The primary outcome was the percentage of patients with an ED return visit within 14 days. We used multivariate logistic regression analyses to identify patient characteristics predictive of at least one ED return visit. RESULTS There were 5,550 patients included in the study. A total of 1,004 (18.1%) of patients had at least one ED return visit, but only 100 patients (1.8%) were admitted to hospital following initial discharge. Common reasons for ED return visits included wound care concerns (17.2%), head injury complaints (15.6%), and substance misuse (6.8%). Rural residence (odds ratio [OR], 1.83; 95% CI, 1.45–2.29), history of anxiety disorder (OR, 2.05; 95% CI, 1.54–2.73), high baseline ED usage (OR, 2.58; 95% CI, 2.03–3.28), penetrating injury (OR, 1.42; 95% CI, 1.20–1.68), and extremity fracture (OR, 1.52; 95% CI, 1.24–1.88) predicted return visits. CONCLUSION Patients discharged directly have high rates of ED return visits but low rates of hospital admission or delayed surgical intervention. Trauma services should expand quality assurance initiatives to capture return visits, understand any gaps in clinical service provision, and aim to minimize unnecessary ED return visits. LEVEL OF EVIDENCE Prognostic/Epidemiological; Level IV.