RESUMEN
BACKGROUND: National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury. METHODS: The Maryland Health Services Cost Review Commission Dataset was queried for 0-19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism. RESULTS: Of 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05). CONCLUSIONS: Pediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions. LEVEL OF EVIDENCE: III (Retrospective Comparative Study).
Asunto(s)
Heridas y Lesiones , Humanos , Maryland/epidemiología , Niño , Adolescente , Preescolar , Factores de Riesgo , Heridas y Lesiones/epidemiología , Heridas y Lesiones/economía , Masculino , Femenino , Lactante , Servicio de Urgencia en Hospital/estadística & datos numéricos , Estudios Retrospectivos , Recién Nacido , Adulto Joven , RecurrenciaRESUMEN
A better understanding of the unique risks for survivors of violence experiencing homelessness could enable more effective intervention methods. The aim of this study was to quantify the risks of death and reinjury for unhoused compared to housed survivors of violent injuries. This retrospective study included a cohort of patients with known housing status presenting to the Boston Medical Center Emergency Department between 2009 and 2018 with a violent penetrating injury. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the risks of all-cause mortality and violent reinjury. Of the 2330 patients included for analysis, 415 (17.8%) were unhoused at the time of index injury. Within 3 years of the index injury, there were 319 (13.9%) violent reinjuries and 55 (2.4%) deaths. Unhoused patients were more likely than housed patients to be violently reinjured by all causes (HR = 1.39, 95% CI = 1.06-1.83, p = 0.02), by stab wound (HR = 2.34, 95% CI = 1.33-4.11, p = 0.0003), and by blunt assault (HR = 1.52, 95% CI = 1.05-2.21, p = 0.03). Housed and unhoused patients were equally likely to die within 3 years of their index injury; however, unhoused patients were at greater risk of dying by homicide (HR = 2.89, 95% CI = 1.34-6.25, p = 0.006) or by a drug/alcohol overdose (HR = 2.86, 95% CI = 1.17-6.94, p = 0.02). In addition to the already high risks that all survivors of violence have for recurrent injuries, unhoused survivors of violence are at even greater risk for violent reinjury and death and fatal drug/alcohol overdose. Securing stable housing for survivors of violence experiencing homelessness, and connecting them with addiction treatment, is essential for mitigating these risks.
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Víctimas de Crimen , Sobredosis de Droga , Personas con Mala Vivienda , Lesiones de Repetición , Humanos , Estudios Retrospectivos , ViolenciaRESUMEN
Violent injury is known to be a chronic, recurrent issue, with high rates of recidivism following initial injury. While the burden of violence is disproportionately felt among young Black men and in communities of color, examination of distinct risk factors and long-term outcomes for other racial and ethnic groups could lead to improved violence intervention strategies. In this study, we examined the risk of violent penetrating injury and long-term adverse outcomes by race and ethnicity. This retrospective study was performed using a cohort of patients presenting to the Boston Medical Center emergency department for a violent penetrating injury between 2006 and 2016. Cox proportional hazards regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) for the risk of all-cause mortality and violent re-injury at one and 3 years after surviving a penetrating injury.Of the 4191 victims of violent injury, 12% were White, 18% were Hispanic, and the remaining 70% self-identified as Black. Within 3 years after initial injury, Black patients were at the greatest risk of all-cause violent re-injury (vs. Hispanic: HR = 1.46, 95%CI[1.15,1.85], p = 0.002; vs. White: HR = 1.89, 95%CI[1.40,2.57], p < 0.0001), particularly by gunshot wound (vs. Hispanic: HR = 2.04, 95%CI[1.29,3.22] p = 0.002; vs. White: HR = 2.34, 95%CI[1.19,4.60], p = 0.01). At 3-years following initial injury, White patients were at 2.03 times the risk for all-cause mortality, likely due to a 4.96 times greater risk of death by drug or alcohol overdose for White patients compared to Black patients (HR = 4.96, 95%CI[2.25,10.96], p < 0.0001). In conclusion, Black survivors of violent injury have a significantly higher risk of violent re-injury, particularly by gun violence, while White patients are at the highest risk for mortality due to the incidence of drug and alcohol overdose. Violence intervention programs with similar patient populations should explore options to collaborate with drug treatment programs to reach this vulnerable population.
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Lesiones de Repetición , Heridas por Arma de Fuego , Masculino , Humanos , Estudios Retrospectivos , Violencia , EtnicidadRESUMEN
BACKGROUND: Traumatic injuries remain one of the leading causes of death in the United States. Patients who survive traumatic injuries but return to the emergency department with repeat injuries are said to suffer from injury recidivism. Numerous studies have described trends in injury recidivism using trauma registry and survey data. To our knowledge, no prior study has leveraged electronic medical record (EMR) data to characterize injury recidivism. The EMR is potentially more comprehensive as it contains details of patients who visited the emergency department after injury but did not meet the criteria for inclusion in the trauma registry. Such injuries could be predictive of future recidivism. We therefore aimed to describe patterns of injury recidivism seen at a Level 1 trauma center using the EMR. METHODS: A retrospective review was conducted of all injury-related encounters between January 2016 and December 2019. Manual review was conducted of all recidivistic encounters with < 11 months between encounters to ensure the recidivistic encounter was not a sequela of the index visit. A general estimating equation logistic regression adjusted for age, race, sex, and insurance payor, estimated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between injury mechanism and odds of recidivistic encounter. RESULTS: A total of 20,566 index encounters was included during the study period. Of the 20,566 encounters, 7.6% (n = 1570) had a recidivistic encounter during the study period, half of which (n = 781) occurred within the first year of the index encounter. An over two-fold increased odds of recidivism was observed for blunt assault encounters (OR 2.53, 95% CI 2.03-3.15) and unintentional falls (OR 2.10, 95% CI 1.76-2.52). For both mechanisms, this increase was observed across the three years following the index encounter. CONCLUSIONS: Our study found that patients with assault injuries have the highest odds of injury recidivism and assault-related recidivistic encounters. These results demonstrate the feasibility and utility of incorporating EMR data, and suggest that the development of targeted interventions focused on mitigating assault injuries, such as hospital-based violence intervention programs, should be considered in our region.
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Registros Electrónicos de Salud , Heridas y Lesiones , Servicio de Urgencia en Hospital , Humanos , Estudios Retrospectivos , Centros Traumatológicos , Estados Unidos/epidemiología , Violencia , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiologíaRESUMEN
PURPOSE: The study aimed to determine the relationship between impulsivity and anxiety and recurrent metacarpal fractures (RMF) due to punching injury. METHODS: Consecutive 368 patients (301 men and 67 women) with metacarpal fracture who met the inclusion criteria and 214 healthy controls were included in the study. The study group was divided into two as the first metacarpal fracture (FMF) (245 patients) and RMF (123 patients). The control group consisted of sex- and age-matched 214 healthy participants (175 men and 39 women). Beck anxiety inventory (BAI), Barratt impulsiveness scale (BIS 11), and Quick DASH scores were the assessment of the patients in the sixth month of treatment. The groups were compared in terms of demographic features (including education status, marital status, work status, and level of income), fracture side, fracture location, dominant hand, treatment, anxiety, impulsivity, and functional results. RESULTS: In the RMF, BIS 11, BAI, and Quick DASH scores were significantly higher than the FMF and the healthy controls (p = 0.001 and p = 0.001, respectively). The patients with RMF have higher impulsivity and anxiety, worse short-term functional outcomes, and lower level of income and education status compared with healthy controls and FMF. CONCLUSION: Anxiety and impulsivity are higher in patients with RMF. It adversely affects the clinical outcome after the treatment. Psychiatric consultation is an important step for especially intentional RMF patients to prevent recurrent hand injuries and metacarpal fractures and to improve clinical outcomes associated with these injuries.