Patients with Penetrating Trauma Have a Greater Risk of Infection-related Readmission

Author(s):
Leonardo Diaz; Melissa Canas; Ricardo Fonseca; Michael Alchaer; Hussain Afzal; Marguerite Spruce; Grant Bochicchio; Lindsay M Kranker

Background:

Readmission within 30 days is a key outcome measure in trauma patients.  Identifying trauma-specific risk factors for readmission to guide prevention during index hospitalization is paramount.

Hypothesis:

We hypothesize that patients with penetrating injuries are more likely to be readmitted due to infection.

Methods:

A retrospective analysis was conducted using data from a prospectively maintained institutional trauma registry between 2018-2022. Based on the 30-day readmission diagnosis, patients were categorized into Infection-related readmission (IRR) and non-infection-related readmission (NIRR). Culture results and antibiotic treatment during readmission were extracted. Demographics, mechanisms of injury (MOI), and outcomes were analyzed. Statistical analyses included t-tests, Mann-Whitney U Test, Chi-square, and binary logistic regression.

Results:

During the study period, 318 of 13,354 trauma patients (2.4%) were readmitted within 30 days. There were 134 (43.8%) patients readmitted for IRR. When comparing IRR with NIRR, patients with IRR were more likely in their index admission to have a penetrating MOI (46.3%), higher Injury Severity Score (15.4 ±10.9 vs 12.6 ±9.3), ICU admission (58.2%), had a longer hospital length of stay (LOS) (13; IQR 8-22 vs 7; IQR 4-12), and ICU LOS (5; IQR 3-9 vs 3; IQR 2-5). The most frequent infection-related diagnoses were necrotizing soft tissue infection / Wound infection (38.8%) followed by intraabdominal infection (31.3%) and urinary tract infection (15.7%). When analyzed by binomial logistic regression, controlling for Injury Severity Score (ISS), Social Vulnerability Index (SVI), ICU admission, Glasgow coma scale (GCS) and MOI, penetrating injuries were found to be independently associated with infection-related readmission in trauma patients (OR 2.358, P 0.002).

Conclusions:

Our findings demonstrate that penetrating injuries have a 2-fold increase in the risk of infection-related readmissions. These results advocate for the development of specialized care protocols and preventive strategies to address this issue effectively. Our study underscores the importance of further research to identify patients at risk for infection-related readmission.