Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Abstract

Introduction Though preventing recurrent violent injury is an important component of a public health approach to interpersonal violence, and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. Methods We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. Results Of 53,908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and Black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million. Conclusions Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the non-trauma centers where many patients seek care.

Identifying Populations at Risk for Child Abuse: A Nationwide Analysis

“…The most common traumatic injuries identified on past admissions were orthopedic injuries, closed-head trauma, and burns. Additionally, having past traumatic injury was significantly associated with eventual hospitalizations for physical abuse, which indicates that a portion of the children with past abuse-related injuries [12,13,18,35] and subsequent hospitalization for abuse were likely cases of missed abuse. This failure of our healthcare system to detect abuse and attempt prevention of further abuse reveals an area for improvement in definitive identification and management of children with abuse.…”

“…The NRD data are also extensively processed to ensure that readmissions are counted as accurately as possible. This is especially important for trauma studies that utilize population-level data since it is possible that admissions related to the index injury could be miscoded as a new injury [18,19]. The NRD also greatly reduces the likelihood of this type of miscoding by collapsing multiple records into one if they involve a transfer or same-day event such as discharge and admission between different hospitals [20].…”

Trauma Recidivism and Mortality Following Violent Injuries in Young Adults

“…1,2 Previously identified risk factors associated with violent trauma include unemployment, lack of medical insurance, minority race, drug or substance abuse, and low income. 3,9,11 Our study population represents an age group previously identified as high-risk for violence-related trauma and captured any assault-related injury to evaluate for mechanism of injury as a potential risk factor. Our findings demonstrated trauma recidivism and mortality due to a second trauma occurred most commonly in patients surviving a GSW as their initial injury, as compared with stab wounds, blunt assault, and nonviolent trauma.…”

“…[3][4][5]9 Past studies have been limited in their ability to accurately capture patients after discharge, as this cohort is often lost to follow-up or present to different hospitals and outpatient providers, which are not captured by databases reviewing inpatient and/or ED admission. 10,11 Furthermore, most fatal firearm injuries occur at the scene or before ED arrival, limiting the ability of surveillance databases to accurately capture mortality rates outside a medical facility.…”

Nonfatal Assaults Among Persons Aged 10–24 Years — United States, 2001–2015

“…The ED is an important implementation setting for prevention, in part because a large proportion of patients will experience a subsequent assault-related injury or premature death within a few years of a treated injury ( 6 , 7 ). For example, one study compared persons aged 14–24 years who sought treatment in the ED and reported substance use in the 6 months before the visit.…”