A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history

• Published in: The journal of trauma and acute care surgery Vol. 75; no. 1; pp. 116 - 121
• Main Authors: McCoy, Andrew M, Como, John J, Greene, Gregory, Laskey, Sara L, Claridge, Jeffrey A
• Format: Journal Article
• Language: English
• Published: United States 01-07-2013
• Subjects: Adaptation, Psychological; Adult; Cohort Studies; Female; Humans; Injury Severity Score; Male; Medical History Taking; Middle Aged; Prognosis; Prospective Studies; Recurrence; Reference Values; Risk Assessment; Stress, Psychological; Trauma Centers; Treatment Outcome; Wounds and Injuries - diagnosis; Wounds and Injuries - psychology; Wounds and Injuries - therapy; Young Adult
• ISSN: 2163-0755; 2163-0763
• DOI: 10.1097/TA.0b013e31829231b7

The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history.
All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries. Recurrent recidivists presented multiple times during the study period.
Of the 4,971 trauma activations during the study period, 1,246 (25.2%) were identified as recidivists. Recidivists were 75% male, 62% white, 36% unemployed, 26% uninsured, and 90% unmarried. The recidivism rate among admitted patients was 23.4% compared with 29.3% in those discharged from the emergency department. The highest recidivism rates were noted in patients who reported alcohol or illegal drug use on the day of injury and in victims of interpersonal violence (IPV), defined as those who sustained gunshot wounds, stab wounds, or assaults, Those involved in IPV were more likely to have been involved in IPV at the previous trauma than those with other trauma mechanisms. Key risk factors for recidivism among all patients were male sex and single marital status. Seventy-three patients (1.5%) were recurrent recidivists, representing 157 unique encounters.
This is the highest trauma recidivism rate reported on a large population of all consecutive trauma activations at a regional Level 1 trauma center. These data illustrate the tremendous burden of recidivism in the modern era, more than previously recognized. Efforts specifically targeting those involved in IPV may reduce recidivism rates. Incorporating the concept of the PTHx into the general history of the trauma patient is feasible and provides valuable information to the provider.
Prognostic study, level II.