Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
EDITORIAL  
Year : 2014  |  Volume : 7  |  Issue : 4  |  Page : 249-250
What's new in emergencies trauma and shock? Outpatient follow-up after traumatic injury: Challenges and opportunities


1 Department of Neurology and Neurosurgery; Johns Hopkins Center for Surgical Trials and Outcomes Research, Baltimore, Maryland, USA
2 Johns Hopkins Center for Surgical Trials and Outcomes Research; Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA

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Date of Submission11-Nov-2013
Date of Acceptance16-Nov-2013
Date of Web Publication13-Oct-2014
 

How to cite this article:
Asemota AO, Schneider EB. What's new in emergencies trauma and shock? Outpatient follow-up after traumatic injury: Challenges and opportunities. J Emerg Trauma Shock 2014;7:249-50

How to cite this URL:
Asemota AO, Schneider EB. What's new in emergencies trauma and shock? Outpatient follow-up after traumatic injury: Challenges and opportunities. J Emerg Trauma Shock [serial online] 2014 [cited 2019 Sep 21];7:249-50. Available from: http://www.onlinejets.org/text.asp?2014/7/4/249/142610


The authors present data on the follow-up of trauma patients after discharge from acute care. They evaluated 2,906 trauma patients of whom approximately a third presented to the index institution for scheduled follow-up within the 2 months period immediately following discharge. The authors report that uninsured patients, as well as persons with Medicaid coverage, were less likely to present for scheduled follow-up outpatient visits and were more likely seen in the emergency department (ED) for any cause within 2 months after discharge than patients with private insurance or Medicare coverage.

We applaud the authors for examining this very important topic and recognize the challenges associated with a study of this nature. We are concerned that the unavailability of data on patients lost to follow-up weaken the generalizability of the findings from this study, which may be subject to "attrition bias". [1] Understanding what may have happened to, in this case the majority of patients, forms an important piece of the puzzle in any analysis of this kind. [2] We are also concerned that using all-cause ED admission as a marker of recidivism may introduce bias - it is possible that those patients who are uninsured or on Medicaid may have other comorbid illnesses or may be at greater risk of injury, and therefore, might be significantly more likely to present for emergency treatment for conditions not related to the primary cause of index treatment compared with those individuals carrying private or Medicare coverage.

Insurance coverage and type are known to be associated with patient age. [2],[3],[4] Other studies have reported age- and gender-related patterns in both recidivism and in the likelihood of presenting for scheduled post-discharge follow-up care among trauma patients. [5],[6] In addition, the absence of detailed information on individual patient comorbidities may bias the study findings. We appreciate that the authors do mention this issue as a limitation of their study; however, we believe that these factors warrant deeper investigation and should be more fully accounted for in future studies. Also, the presence of coexisting illnesses in persons suffering acute trauma may be an indication for more intensive follow-up after discharge and put such patients at increased risk of unscheduled ED presentation. [7],[8]

Attributing the likelihood of participating in scheduled follow-up to the type or lack of health insurance coverage appears to have validity on its face; however, the lack of information on those patients who do not present for scheduled follow-up, along with an inadequate ability to understand and control for other coexisting illnesses, limits the potential impact of this otherwise well done study. As the US healthcare system moves toward the "accountable care" model, developing a more complete understanding of the patterns of how patients as individuals and in groups use, or fail to take advantage of, healthcare resources and provider recommendations will be critically important. We commend the authors for their vision and for their effort in studying this very challenging and complex topic in trauma patients and we look forward to further and increasingly robust study from their group.

 
   References Top

1.
Howe LD, Tilling K, Galobardes B, Lawlor DA. Loss to follow-up in cohort studies: Bias in estimates of socioeconomic inequalities. Epidemiology 2013:24:1-9.  Back to cited text no. 1
    
2.
Leukhardt WH, Golob JF, McCoy AM, Fadlalla AM, Malangoni MA, Claridge JA. Follow-up disparities after trauma: A real problem for outcomes research. Am J Surg 2010;199:348-52.  Back to cited text no. 2
    
3.
Gadomski A, Jenkins P, Nichols M. Impact of a Medicaid primary care provider and preventive care on pediatric hospitalization. Pediatrics 1998;101:E1.  Back to cited text no. 3
    
4.
Dombkowski KJ, Stanley R, Clark SJ. Influence of Medicaid managed care enrollment on emergency department utilization by children. Arch Pediatr Adolesc Med 2004;158:17-21.  Back to cited text no. 4
    
5.
Kwan RO, Cureton EL, Dozier KC, Victorino GP. Gender differences among recidivist trauma patients. J Surg Res 2011;165:25-9.  Back to cited text no. 5
    
6.
Iglehart JK. Medicaid and managed care. N Engl J Med 1995;332:1727-31.  Back to cited text no. 6
[PUBMED]    
7.
McCoy AM, Como JJ, Greene G, Laskey SL, Claridge JA. A novel prospective approach to evaluate trauma recidivism: The concept of the past trauma history. J Trauma Acute Care Surg 2013;75:116-21.  Back to cited text no. 7
    
8.
Misky GJ, Wald HL, Coleman EA. Post-hospitalization transitions: Examining the effects of timing of primary care provider follow-up. J Hosp Med 2010;5:392-7.  Back to cited text no. 8
    

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Correspondence Address:
Dr. Anthony O Asemota
Department of Neurology and Neurosurgery; Johns Hopkins Center for Surgical Trials and Outcomes Research, Baltimore, Maryland
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.142610

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