Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Håkon Øgreid Moksnes; Christoph Schäfer; Mari Storli Rasmussen; Helene Lundgaard Søberg; Olav Røise; Audny Anke; Cecilie Røe; Pål Aksel Næss; Christine Gaarder; Eirik Helseth; Hilde Margrete Dahl; Morten Hestnes; Cathrine Brunborg; Nada Andelic; Torgeir Hellstrøm

doi:10.1186/s40621-023-00431-y

Factors associated with discharge destination from acute care after moderate-to-severe traumatic injuries in Norway: a prospective population-based study

Inj Epidemiol. 2023 Apr 13;10(1):20. doi: 10.1186/s40621-023-00431-y.

Authors

Håkon Øgreid Moksnes^{1

2}, Christoph Schäfer^{3

4

5

6}, Mari Storli Rasmussen^{3

4

7}, Helene Lundgaard Søberg^{3

7}, Olav Røise^{8

9}, Audny Anke^{4

5

6}, Cecilie Røe^{3

4

9}, Pål Aksel Næss^{9

10}, Christine Gaarder^{9

10}, Eirik Helseth^{9

11}, Hilde Margrete Dahl^{9

12}, Morten Hestnes^{13

14}, Cathrine Brunborg¹⁵, Nada Andelic^{3

4}, Torgeir Hellstrøm³

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway. hakmok@ous-hf.no.
² Faculty of Medicine, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, P.O. Box 1072, Blindern, 0316, Oslo, Norway. hakmok@ous-hf.no.
³ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
⁴ Faculty of Medicine, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, University of Oslo, P.O. Box 1072, Blindern, 0316, Oslo, Norway.
⁵ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, P.O. Box 6050, Langnes, 9037, Tromsø, Norway.
⁶ Department of Rehabilitation, University Hospital of North Norway, P.O. Box 100, 9038, Tromsø, Norway.
⁷ Faculty of Health Sciences, Oslo Metropolitan University, P.O. Box 4, St. Olavs Plass, 0130, Oslo, Norway.
⁸ Norwegian Trauma Registry, Division of Orthopaedic Surgery, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
⁹ Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, P.O. Box 1072, Blindern, 0316, Oslo, Norway.
¹⁰ Department of Traumatology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
¹¹ Department of Neurosurgery, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
¹² Department of Child Neurology, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
¹³ Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
¹⁴ Oslo University Hospital Trauma Registry, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.
¹⁵ Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway.

Abstract

Background: Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries.

Methods: A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020).

Results: In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1-6, where 1 is most central], we found that patients residing in NCI 3-4 and 5-6 areas sustained more severe injuries than patients residing in NCI 1-2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80-13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3-4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated.

Conclusions: Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination.

Keywords: Discharge destination; Epidemiology; Multiple injury; Trauma; Trauma center; Traumatic injury.

Grants and funding

2019043/Helse Sør-Øst RHF