Undiagnosed Diseases Are Common Among Young Trauma Patients
By Melinda Young
There is a largely untapped opportunity for health systems to identify young adults with chronic diseases before they end up hospitalized for their illness. Trauma, such as car crashes, falls, assaults, and gunshot wounds, can be the entry point to the healthcare system, according to researchers.1
“We used to think it was a young, healthy 20-year-old who comes in with a gunshot wound. That paradigm is no longer true,” says Ursula Adams, MD, MBA, a research fellow at WakeMed Health and Hospitals in Raleigh, NC. Adams also is a general surgery resident at the University of North Carolina Hospitals in Chapel Hill. “That young 20-year-old is not as healthy as they once were. Most people in their college years and post-graduate years don’t see doctors.”
Young adults know about preventive care, but they often do not bother with it because they assume they are young and healthy. As their responsibilities grow with jobs and families and child care, they are even less likely to take time off of work to see a physician.
The study’s findings should help dispel the belief that young patients are largely healthy, Adams notes. “Any patient who is coming into the hospital for a nonelective reason, we should be concerned about — especially in the trauma population, which is vulnerable and at high risk for a lot of reasons,” she explains. “No longer can these patients be assumed to be healthy. These patients need the same screening and attention that a 67-year-old would get.” For example, trauma centers should screen each of these young adult trauma patients for blood pressure issues and diabetes.
Adams and colleagues conducted a retrospective cohort study of adult trauma patients, ages 18 to 40 years, who had been admitted to one of three participating Level I trauma centers through the ED between January 2018 and December 2020. They collected data on more than 6,300 patients and found that 76.8% showed evidence of at least one undiagnosed condition. Hypertension and obesity were the most prevalent diseases in this population, and they were highly underdiagnosed. The highest proportions of undiagnosed disease were among younger patients, men, non-Hispanic Black patients, and Hispanic patients.
“We wanted to categorize the prevalence of four chronic diseases in this population because we didn’t know what the prevalence would be,” Adams explains. “We looked at high blood pressure, diabetes, obesity, and alcohol and substance use, which were grouped together.”
Adams and colleagues categorized patients as having a diagnosis of these diseases or having risk factors or evidence in their chart but were undiagnosed. Then, they compared groups of patients and found that about nine out of 10 young adults seen in the trauma centers showed evidence of a chronic disease, and close to 40% were diagnosed with one of the diseases.
“That’s a large number that says we know there is a high [amount of] disease in this population,” Adams says. “There is a huge percentage of this population that has evidence of one of these diseases but does not carry a diagnosis.”
Adams and colleagues also found that only 12.2% of patients were referred to their primary care provider (PCP) at discharge for follow-up care or to establish care. Those who were healthy with no diagnoses were the least likely to be referred to a PCP.
Hospital case managers, social workers, nurses, and physicians need to keep in mind the reasons these patients have not visited a PCP. It could be they do not have insurance or cannot take time off work.
“They just had a trauma admission where they lost a lot of work,” Adams adds. “It’s not unusual for a patient to say, ‘I’m going to lose my job if I stay in the hospital another day.’”
Case managers could help patients find a nearby PCP, and social workers could help them enroll in Medicaid or Affordable Care Act insurance if they are eligible.
“You have to figure out ways to screen, prevent, and treat these patients while they’re still in the hospital,” Adams says. “It’s tricky because hospitals are already heavily burdened with high volumes.”
However, it is an important way for health systems to help their populations maintain their health and prevent hospitalizations and ED visits for flare-ups of chronic illness.
“Our work at WakeMed is going to be focused on finding the most cost-effective [method] for patients and healthcare systems and to find feasible solutions to address the chronic disease we see in these patients,” Adams says.
Care coordination programs that help young adults navigate the healthcare system and help them find ways to decrease their burden in seeking care will be part of the solution.
“Case management can help with bed turnover,” Adams says. “We rely so heavily on case management. They have insight into everything beyond the hospital and all the options.”
Physicians know that when case managers are involved, their patients will receive good, safe care after leaving the hospital. “Case management helps patients as a whole and helps the community because they’re developing good solutions, and all of the case managers I’ve interacted with certainly do that,” Adams says. “I wish I had double the number of them.”
- Adams U, Tremont JP, Yohann A, et al. Cues to care: Chronic disease diagnosis in young adult trauma patients. J Trauma Acute Care Surg 2023; Oct 3. doi: 10.1097/TA.0000000000004149. [Online ahead of print].
There is a largely untapped opportunity for health systems to identify young adults with chronic diseases before they end up hospitalized for their illness. Trauma, such as car crashes, falls, assaults, and gunshot wounds, can be the entry point to the healthcare system, according to researchers.
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