Outpatient Follow-up Is Associated With Reduced Unplanned Emergency Department Return Visits After Mild Traumatic Brain Injury Among Hispanic Patients

Our society comprises culturally diverse populations. The Emergency Department (ED) often serves as the initial point of contact with the healthcare system. Patient-centered care that incorporates cultural considerations can improve health outcomes and optimize healthcare resource utilization. In a prior study examining factors associated with unplanned return visits (URV) to the ED after evaluation for mild traumatic brain injury (mTBI), Hispanic patients demonstrated higher rates compared with other patient groups. The objective of this study was to identify predictive factors associated with reduced URV among Hispanic patients.

This was a retrospective chart review of patients presenting to a single academic ED between January 2022 - December 2024 and identified as Hispanic or Latino. Patients under 16 years or those with findings on imaging were excluded. The primary outcome was an URV related to the index injury within 8 weeks. Additional data consisted of demographics, imaging, discharge instructions, primary care (PCP), and follow-up plans. Uni- and multivariate analyses controlling for covariates were performed.

Of the 733 patients that met inclusion criteria, this sub study included data from 141 Hispanic patients (61.0% females, avg. age 36.7±14.3 years). URV occurred in 29 patients (20.6%). Imaging at indexed visit (No URV = 64.3%, URV=48.3%, p=0.115), discharge instructions with education (No URV = 77.7%, URV=72.4%, p=0.551), referral for follow-up (No URV = 56.3%, URV=65.5%, p=0.3647), established PCP (No URV = 52.7%, URV=69.0%, p=0.253), nor interpreter needed during visit (No URV = 15.2%, URV=10.3%, p=0.601) were associated with URVs. There was a difference in URV rates when the patient was seen for follow-up care in the outpatient setting (No URV = 42.9%, URV=20.7%, p=0.029). After controlling sex, PCP status, insurance status, and age, patients who were seen in outpatient follow-up had 3.6x lower odds (aOR: 3.6, 95%CI: 1.2-10.5, p=0.015) of URV compared to patients who were not seen in follow-up.

Continuation of the care continuum in the outpatient setting was the primary factor associated with limiting URV following a mTBI. Emphasizing the importance of follow-up for mTBI, which has the potential to have lingering symptoms for several weeks after the initial injury, may be an important component of the patient-center care among Hispanic patients.