Trauma clinic follow-up: Predictors of nonattendance and patient-reported reasons for no show

Abstract

Introduction

The objectives of this study were to identify factors associated with nonattendance to follow-up in patients seen for traumatic hand and facial injuries at an urban Level 1 trauma center and to elucidate patient-reported reasons for nonattendance.

Methods

A retrospective chart review was performed for all patients seen for hand and facial trauma at our institution over a 2-year period. Demographic data, including race, insurance status, and incomes based on zip code data, were collected for all patients. Injury patterns, interventions, and patient disposition were analyzed. A binomial multivariate logistic regression was conducted to identify predictors of nonattendance to follow-up. All patients who were lost to follow-up over the last 12-month period were contacted via phone to identify reasons for nonattendance to determine whether they had followed up with another provider and to analyze long-term injury sequelae.

Results

After exclusion criteria were applied, there were 889 patients included in the analysis, with 31% of patients lost to follow-up. Factors significantly associated with follow-up nonattendance included patients who sustained injuries from gunshot wounds or assault, had no insurance or were out of network, and who received no acute intervention for their injuries. Forearm, wrist, and fingers fractures; facial fractures and lacerations; performing a procedure in the ED or operating room; and commercial insurance were all independent predictors of clinic attendance. The most common reasons for nonattendance cited by patients were “did not feel the need” (28%), lack of transportation (20%), and scheduling conflicts (19%).

Conclusions

Clinic follow-up for patients sustaining hand and facial trauma at a Level 1 trauma center is impacted by the socioeconomic factors that make this patient population particularly vulnerable to injury.