Rural individuals most likely to have recurrent trauma center admissions

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Rate of recurrent injury

About 3.4 percent of patients treated in rural trauma centers appear to be recidivists, meaning that they have visited the facility more than once for separate injuries, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. Substance abuse appears to be the common feature among urban and rural recurrent trauma patients.

Trauma is the leading cause of death and disability for individuals age 40 and younger, according to background information in the article. Historically, trauma centers have focused on reducing death and disability following injury; however, it is now recognized that like other diseases, trauma affects certain individuals in high-risk groups. "Correspondingly, the primary prevention of injury has become implicit in the development of integrated trauma systems," the authors write. "The identification of individuals at risk for injury has led to the development of preventative measures to reduce predisposing behavior." Recurrent injury, or trauma recidivism, has been recognized as a behavior that is costly and leads to additional illness in trauma centers.

Eric A. Toschlog, M.D., and colleagues at The Brody School of Medicine at East Carolina University and University Health Systems of Eastern Carolina, Greenville, assessed 15,370 consecutive patients admitted to one rural, university, level I trauma center between 1994 and 2002. A national trauma registry was used to identify patients who were admitted for distinct injuries two, three, four and five times during the study period. Demographic and clinical information, including blood alcohol levels and toxicology results, were obtained from the same database.

A total of 528 patients (3.4 percent) were admitted to the trauma center a second time for a different injury; the total cost for these admissions was more than $7 million. Compared with patients admitted only once, patients with recurrent admissions for trauma (recidivists):

  • Were older (55.9 years vs. 39.7 years)

  • Were disproportionately white (65.2 percent vs. 56.5 percent)

  • Were more often female (49.1 percent vs. 37.3 percent)

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  • Had a higher percentage of positive blood alcohol screening results (58.7 percent vs. 39.9 percent)

  • Had higher average blood ethanol levels (132.1 milligrams per deciliter vs. 69.5 milligrams per deciliter)

  • Had higher rates of cocaine use (6.4 percent vs. 4.1 percent)

  • Were more likely to be injured in a fall (63.8 percent of those admitted three to five times and 47.2 percent of those admitted twice vs. 24.4 percent of those admitted only once)

  • Were less likely to be injured in a vehicle accident (10.3 percent of those admitted three to five times and 28.4 of those admitted twice vs. 48.1 percent of non-recidivists)

The rate of recurrent injury was lower than that in urban trauma centers (which range from 6.4 percent to 52 percent), and many of these characteristics differ from those found in studies of trauma recidivists in urban populations, who tend to be young, male and injured by violent means, the authors write. "The common feature seems to be substance abuse," they conclude. "Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations."

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