Abstract
PurposeAlthough trauma represents a leading cause of morbidity and mortality worldwide, there is limited and heterogeneous evidence regarding trauma recidivism and its outcomes. This analysis determined the rate and independent risk factors of trauma recidivism and compared the first and second injury episode among recidivists.MethodsAn IRB-approved retrospective cohort study was performed with data from the Puerto Rico Trauma Hospital Registry. Bivariate analyses were done using Pearson’s Chi squared, Wilcoxon rank-sum, McNemar, Stuart-Maxwell or Wilcoxon signed-rank tests, as appropriate. Independent predictors for recidivism were determined through a logistic regression model. Statistical significance was set at p < 0.05.Results24,650 patients were admitted to the hospital during 2000–2017. Recidivism rate was 14 per 1,000 patients discharged alive. Males and individuals aged 15–24 years old were 3.88 (95% CI: 2.21–6.80) and 3.80 (95% CI: 2.24–6.46) times more likely to be recidivists, respectively. Contrariwise, an ISS ge 25 [adjusted odds ratio (AOR) = 0.44; 95% CI: 0.28–0.68] and a GCS le 8 (AOR = 0.56; 95% CI 0.34–0.92) were protective factors. Furthermore, recidivists exhibited less in-hospital mortality than their non-recidivist counterparts (7.2% vs. 10.7%; p = 0.045).For recidivists, the median (interquartile range) time to reinjury was 42 (59) months; and the second injury episode was more severe than the first one, as the proportion of patients with ISS ge 25 increased (7.9% vs. 14.1%; p = 0.022).ConclusionThe independent predictors of trauma recidivism and the median time to reinjury identified in this study provide valuable information to the development of prevention strategies aimed at reducing the burden of injury.
Highlights
Trauma kills over five million people globally in a year, generating 9% of the world’s mortality [1]
A total of 24,650 patients were admitted to the Puerto Rico Trauma Hospital (PRTH) during the study period
Comparing the first and second traumatic incidents of PRTH recidivists, findings disclosed more violence-related injuries on their second occurrence; whilst the contrary occurred with motor vehicle-related trauma
Summary
Trauma kills over five million people globally in a year, generating 9% of the world’s mortality [1]. In the United States (US), trauma contributes to two of the ten leading causes of death—unintentional injuries and suicides—and the leading cause of death in individuals aged 1–44 years old [2]. There is limited data regarding a rare population of trauma patients that present an injury on two or more separate occasions (recidivists). A couple of studies reported recidivists were likely to present the same mechanism of traumatic injury in a subsequent admission as in the first injury [5, 10]. Due to the heterogeneous classification of mechanisms of injury, the prevalence and trends of mechanisms associated with recidivism remain unclear
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