Correlates of Reinjury Risk in Sibling Groups: A Prospective Observational Study

Abstract

The objective of this study was to identify child, parent, and family characteristics that are associated with short-term recurrence of injury within sibling groups. A prospective cohort study was conducted of 92 children who were aged 0 to 15 years and treated for injury at a regional pediatric trauma center and their 166 siblings. The outcome of interest was a second or subsequent injury in the sibling group, occurring within 3 months of the index injury event. Explanatory variables included injury variables, child factors (age, gender, previous injury experience, behavior problems, and traumatic stress symptoms), parental factors (age, education, social support, depressive symptoms, and traumatic stress symptoms), and family factors (socioeconomic status, family function, family structure, and life events). Poisson regression was used in multivariable models with statistical adjustment for clustering within sibling groups. More than 19% of families had at least 1 child injured or reinjured during 3 months of follow-up. The rate of reinjury to index children (8.7%) was similar to that in siblings (7.2%). Controlling for age, gender, and race, the risk for reinjury during follow-up was increased with single-parent family structure (relative risk [RR]: 3.39 [95% confidence interval (CI): 1.69-6.80]), receipt of public assistance (RR: 3.65 [95% CI: 1.61-8.28]), and clinically significant posttraumatic stress disorder arousal symptoms in the child (RR: 3.76 [95% CI: 1.51-9.33]). Along with their siblings, children who receive treatment for injury are at short-term risk for additional injury. Children in single-parent households, in families who receive public assistance, and those with posttraumatic stress disorder arousal symptoms 1 month after injury to themselves or a sibling are at highest risk. These associations could be used to develop interventions to identify and support families through periods of high injury risk.