Identifying Risk Factors for Readmission amongst Unhoused Burn Patients

Abstract

Previous studies have used national data to assess readmission risk factors for patients with burn injury. This study sought to identify risk factors for readmission amongst unhoused burn patients. The 2022 Nationwide Readmissions Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, was used for this study. Patients with International Classification of Diseases Version 10 codes for burn or corrosive injury between January 1, 2022, to November 30, 2022, were included in analysis. Readmission was defined as a subsequent encounter within 30 days with a diagnosis of burn. 18,607 encounters were identified as index admissions, 1,130 (6.1%) were unhoused. 8.6% of unhoused patients (n=97) were readmitted with a diagnosis of burn injury compared to 5.2% (n=908) of housed patients (p<0.001). Risk factors for readmission for unhoused patients included a third-degree burn (OR 2.4, [1.4-4.2], p<0.001), leaving against medical advice (OR 4.1, [2.6-6.6], p<0.001), burn of the trunk (OR 1.9, [1.2-3.0], p<0.001), burn of the upper extremity (OR 1.9, [1.2-3.0], p<0.001), and burn of the lower extremity (OR 1.6, [1.0-2.6], p=0.004). Despite higher rates of diagnoses such as schizophrenia, bipolar disorder, alcohol abuse, and/or substance abuse in the unhoused population, these factors did not increase risk for readmission. Unhoused burn patients were at higher risk of readmission than housed patients, even when adjusting for other risk factors for readmission. Severity of injury, location of injury, and leaving against medical advice were associated with readmission amongst unhoused patients. Leaving against medical advice was a potentially modifiable risk factor identified for readmission risk mitigation in this study.