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Price MD, McDermott KM, An D, Aslam U, Slidell MB, Nasr IW. Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC). J Pediatr Surg 2024; 59:1865-1874. [PMID: 38705831 PMCID: PMC11309908 DOI: 10.1016/j.jpedsurg.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/20/2024] [Accepted: 04/05/2024] [Indexed: 05/07/2024]
Abstract
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).
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Affiliation(s)
- Matthew D Price
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Katherine M McDermott
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel An
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Usman Aslam
- Division of Trauma and Acute Care Surgery, Honorhealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Mark B Slidell
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Isam W Nasr
- Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Lehane A, Wood E, Pranikoff S, Avery M, Pranikoff T. Pediatric and Young Adult Trauma Recidivism. Am Surg 2024; 90:2182-2187. [PMID: 38653577 DOI: 10.1177/00031348241248698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Unintentional injury is the leading cause of death among children. Much can be gleaned from the adult literature in understanding the characteristics that lead to recidivism in efforts to establish interventions for prevention. Our study aims to evaluate the rates, demographics, and features of pediatric trauma recidivism. METHODS This was a retrospective single-institution review at a level-1 pediatric trauma center of children and young adults (ages 0-28) with traumatic injuries from January 2008 to April 2023. Patients with 1 or more prior visits to our institution's trauma center (recidivists) were identified and compared with those with single admissions. Chi-square tests were used to statistically analyze the two groups. RESULTS Pediatric/young adult trauma recidivists were 4.4% of the total trauma population captured (n = 14,613). Of the total trauma group, 55% were under 18 years old. Recidivists had higher percentages of patients who were male (82% vs 69%, P < .01), African American (36% vs 24%, P < .01), involved in penetrating trauma (33% vs 17%, P < .01), self-pay/uninsured (17% vs 12%, P < .01), and have abuse reported (5% vs 4%, P = .04). The primary county for recidivism patients was Forsyth with most patients from a specific zip code in an urban area of the county. The average time between visits for recidivists was 1,066 days. CONCLUSIONS Pediatric/young adult trauma recidivism is associated with specific characteristics including male, African American race, penetrating trauma, and uninsured status. Recidivists are primarily presenting from a zip code with low socioeconomic status. It is critical to develop targeted interventions to help this population in trauma prevention.
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Affiliation(s)
- Alison Lehane
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Elizabeth Wood
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Sarah Pranikoff
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Martin Avery
- Department of Surgery, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Thomas Pranikoff
- Division of Pediatric Surgery, Department of Surgery, Brenner Children's Hospital, Winston-Salem, NC, USA
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Cho NY, Vadlakonda A, Mallick S, Curry J, Sakowitz S, Tran Z, Benharash P. Discharge against medical advice in trauma patients: Trends, risk factors, and implications for health care management strategies. Surgery 2024; 176:942-948. [PMID: 38971696 DOI: 10.1016/j.surg.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/28/2024] [Accepted: 06/03/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVE Given the nonelective nature of most trauma admissions, patients who experience trauma are at a particular risk of discharge against medical advice. Despite the risk of unplanned readmission and financial burden on the health care system, discharge against medical advice among hospitalized patients continues to rise. The present study aimed to assess evolving trends and outcomes associated in patients with discharge against medical advice among patients hospitalized for traumatic injury. METHODS The 2016-2020 Nationwide Readmissions Database was queried to identify all hospitalizations for traumatic injuries. The patient cohort was stratified into those who had discharge against medical advice and those who did not. Temporal trends of discharge against medical advice and associated costs over time were evaluated using nonparametric tests. Multivariable regression models were developed to assess factors associated with discharge against medical advice. Associations of discharge against medical advice with length of stay, hospitalization costs, and unplanned 30-day readmission were subsequently evaluated. RESULTS Of an estimated 4,969,717 patients, 65,354 (1.3%) had discharge against medical advice after hospitalization for traumatic injury. Over the study period, the incidence of discharge against medical advice increased (nptrend <0.001). After risk adjustment, older age (adjusted odds ratio, 0.98/per year; 95% confidence interval, 0.97-0.98), female sex (adjusted odds ratio, 0.65; 95% confidence interval, 0.64-0.67), and management at high-volume trauma center (adjusted odds ratio, 0.71; 95% confidence interval, 0.69-0.74) were associated with lower odds of discharge against medical advice. Compared with others, discharge against medical advice was associated with decrements in length of stay by 1.3 days (95% confidence interval, 1.1-1.5 days) and index hospitalization costs by $2,200 (5% confidence interval, $1,600-2,900), while having a greater risk of unplanned 30-day readmission (adjusted odds ratio, 2.21; 95% confidence interval, 2.06-2.36). CONCLUSION The incidence of discharge against medical advice and its associated cost burden have increased in recent years. Community-level interventions and institutional efforts to mitigate discharge against medical advice may improve the quality of care and resource allocation for patients with traumatic injuries.
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Affiliation(s)
- Nam Yong Cho
- Department of Surgery, University of California, Los Angeles, CA. https://twitter.com/NamYong_Cho
| | | | - Saad Mallick
- Department of Surgery, University of California, Los Angeles, CA
| | - Joanna Curry
- Department of Surgery, University of California, Los Angeles, CA
| | - Sara Sakowitz
- Department of Surgery, University of California, Los Angeles, CA
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, CA. https://twitter.com/DrZacharyTran
| | - Peyman Benharash
- Department of Surgery, University of California, Los Angeles, CA.
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Stephens CQ, Melhado CG, Shui AM, Yap A, Moses W, Jensen AR, Newton C. Factors associated with trauma recidivism in young children. J Trauma Acute Care Surg 2024; 97:421-428. [PMID: 38189666 DOI: 10.1097/ta.0000000000004244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Trauma recidivism is associated with future trauma-associated morbidity and mortality. Previous evidence suggests that socioeconomic factors predict trauma recidivism in older children (10-18 years); however, risk factors in US children 10 years and younger have not been studied. We sought to determine the factors associated with trauma recidivism in young children 10 years and younger. METHODS We conducted a retrospective cohort study of pediatric trauma patients 10 years and younger who presented to a single American College of Surgeons-verified Level I pediatric trauma center from July 1, 2017, to June 30, 2021. All patients were evaluated for prior injury during trauma registry entry. Characteristics at the index injury were collected via chart review. Patients were geocoded to assess Social Vulnerability Index. Logistic regression examined factors associated with recidivism. Best subset selection was used to compare multivariable models and identify the most predictive and parsimonious model. Statistical significance was set at p < 0.05. RESULTS Of the 3,518 patients who presented in the study period, 169 (4.8%) experienced a prior injury. Seventy-six percent (n = 128) had one prior injury presentation, 18% (n = 31) had two prior presentations, and 5.9% (n = 10) had three or more. Falls were the most common mechanism in recidivists (63% vs. 52%, p = 0.009). Child physical abuse occurred in 6.5% of patients, and 0.9% experienced penetrating injury. The majority (n = 137 [83%]) were discharged home from the emergency department. There was no significant difference in the frequency of penetrating injury and child physical abuse between recidivists and nonrecidivists. Following logistic regression, the most parsimonious model demonstrated that recidivism was associated with comorbidities, age, falls, injury location, nontransfer, and racialization. No significant associations were found with Social Vulnerability Index and insurance status. CONCLUSION Medical comorbidities, young age, injury location, and falls were primarily associated with trauma recidivism. Support for parents of young children and those with special health care needs through injury prevention programs could reduce trauma recidivism in this population. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Caroline Q Stephens
- From the Division of Pediatric Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), UCSF Benioff Children's Hospitals; Department of Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), and Department of Epidemiology and Biostatistics (A.M.S.), University of California, San Francisco, San Francisco, California
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Francis M. Holistic Approach to Gun Violence. J Holist Nurs 2024; 42:291-299. [PMID: 37908077 DOI: 10.1177/08980101231207697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The purpose of this manuscript is to provide holistic practice strategies for the care of victims of gun violence. Gun violence is a public health crisis with a significant increase following the pandemic. The impact of Covid-19 restrictions placed an increase burden on some communities already overwhelmed with poverty, crime, and deteriorating homes. The overrepresentation of African American males as victim of gun violence indicates a health care disparity which needs to be addressed. The Theory of Reasoned Action and Theory of Planned Behavior are a theoretical framework that provides insight to the social behaviors associated with gun violence. The holistic approach recognizes the interconnection between individuals and environment, in order to facilitate the healing process for victims of gun violence, social factors and environment must be incorporated into their care.
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Affiliation(s)
- Mary Francis
- Widener University, Chester, PA, USA
- Cooper University Hospital, Camden, NJ, USA
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Hartline J, Cosgrove CT, O'Hara NN, Ghulam QM, Hannan ZD, O'Toole RV, Sciadini MF, Langhammer CG. Socioeconomic status is associated with greater hazard of post-discharge mortality than race, gender, and ballistic injury mechanism in a young, healthy, orthopedic trauma population. Injury 2024; 55:111177. [PMID: 37972486 DOI: 10.1016/j.injury.2023.111177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To explore the utility of legacy demographic factors and ballistic injury mechanism relative to popular markers of socioeconomic status as prognostic indicators of 10-year mortality following hospital discharge in a young, healthy patient population with isolated orthopedic trauma injuries. METHODS A retrospective cohort study was performed to evaluate patients treated at an urban Level I trauma center from January 1, 2003, through December 31, 2016. Current Procedure Terminology (CPT) codes were used to identify upper and lower extremity fracture patients undergoing operative fixation. Exclusion criteria were selected to yield a patient population of isolated extremity trauma in young, otherwise healthy individuals between the ages of 18 and 65 years. Variables collected included injury mechanism, age, race, gender, behavior risk factors, Area Deprivation Index (ADI), and insurance status. The primary outcome was post-discharge mortality, occurring at any point during the study period. RESULTS We identified 2539 patients with operatively treated isolated extremity fractures. The lowest two quartiles of socioeconomic status (SES) were associated with higher hazard of mortality than the highest SES quartile in multivariable analysis (Quartile 3 HR: 2.2, 95% CI: 1.2-4.1, p = 0.01; Quartile 4 HR: 2.2, 95% CI: 1.1-4.3, p = 0.02). Not having private insurance was associated with higher mortality hazard in multivariable analysis (HR 2.0, 95% CI: 1.3-3.2, p = 0.002). The presence of any behavioral risk factor was associated with higher mortality hazard in univariable analysis (HR: 1.8, p < 0.05), but this difference did not reach statistical significance in multivariable analysis (HR: 1.4, 95%: 0.8-2.3, p = 0.20). Injury mechanism (ballistic versus blunt), gender, and race were not associated with increased hazard of mortality (p > 0.20). CONCLUSION Low SES is associated with a greater hazard of long-term mortality than ballistic injury mechanism, race, gender, and medically diagnosable behavioral risk factors in a young, healthy orthopedic trauma population with isolated extremity injury.
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Affiliation(s)
- Jacob Hartline
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher T Cosgrove
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Nathan N O'Hara
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Qasim M Ghulam
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Zachary D Hannan
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Robert V O'Toole
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Marcus F Sciadini
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD
| | - Christopher G Langhammer
- R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD.
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Heimke IM, Furdock R, Simske NM, Swetz A, Simpson M, Breslin MA, Hendrickson SB, Moore TA, Vallier HA. Trauma recidivism is reduced with engagement in psychosocial programming following orthopaedic trauma. Injury 2023; 54:111129. [PMID: 37880032 DOI: 10.1016/j.injury.2023.111129] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Recidivism is common following injury. Interventions to enhance patient engagement may reduce trauma recidivism. Education, counseling, peer mentorship, and other resources are known as Trauma Recovery Services (TRS). The authors hypothesized that TRS use would reduce trauma recidivism. METHODS Over five years at a level 1 trauma center, 954 adults treated operatively for pelvic, spine, and femoral fractures were reviewed. Recidivism was defined as return to trauma center for new injury within 30-months. All patients were offered TRS. Multivariate logistic regression statistical analysis was used to identify predictors of recidivism. RESULTS Three hundred and ninety-seven of all patients (42 %) utilized TRS, including educational materials (n = 293), peer visits (n = 360), coaching (n = 284), posttraumatic stress disorder (PTSD) screening (n = 74), and other services. Within the entire sample, 136 patients (14 %) returned to the emergency department for an unrelated trauma event after mean 21 months. 13 % of TRS users became recidivists. Overall, 49 % of recidivists had history of pre-existing mental illness. High rates of TRS engagement between recidivists and non-recidivists were seen (75 %); however, non-recidivists were more likely to use multiple types of recovery services (49 % vs 34 %, p = 0.002), and were more likely to engage with trauma peer mentors (former trauma survivors) more than once (91 % vs 81 %, p = 0.03). After multivariable analysis, patients using multiple different recovery services had a lower risk of recidivism (p = 0.04, OR 0.42, 95 % CI [0.19-0.96]). CONCLUSIONS Multifaceted engagement with recovery programming is associated with less recidivism following trauma. Future study of resultant reductions in healthcare costs are warranted. LEVEL OF EVIDENCE Level II; Prognostic.
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Affiliation(s)
- Isabella M Heimke
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Ryan Furdock
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Natasha M Simske
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Anna Swetz
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Megen Simpson
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Mary A Breslin
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Sarah B Hendrickson
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Timothy A Moore
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States
| | - Heather A Vallier
- MetroHealth Medical Center, Western Reserve University, Cleveland, OH, United States.
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Cho NY, Mabeza RM, Bakhtiyar SS, Richardson S, Ali K, Tran Z, Benharash P. National trends and resource associated with recurrent penetrating injury. PLoS One 2023; 18:e0280702. [PMID: 37967100 PMCID: PMC10650986 DOI: 10.1371/journal.pone.0280702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/22/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND While recurrent penetrating trauma has been associated with long-term mortality and disability, national data on factors associated with reinjury remain limited. We examined temporal trends, patient characteristics, and resource utilization associated with repeat firearm-related or stab injuries across the US. METHODS This was a retrospective study using 2010-2019 Nationwide Readmissions Database (NRD). NRD was queried to identify all hospitalizations for penetrating trauma. Recurrent penetrating injury (RPI) was defined as those returned for a subsequent penetrating injury within 60 days. We quantified injury severity using the International Classification of Diseases Trauma Mortality Prediction model. Trends in RPI, length of stay (LOS), hospitalization costs, and rate of non-home discharge were then analyzed. Multivariable regression models were developed to assess the association of RPI with outcomes of interest. RESULTS Of an estimated 968,717 patients (28.4% Gunshot, 71.6% Stab), 2.1% experienced RPI within 60 days of the initial injury. From 2010 to 2019, recurrent gunshot wounds increased in annual incidence while that of stab cohort remained stable. Patients experiencing recurrent gunshot wounds were more often male (88.9 vs 87.0%, P<0.001), younger (30 [23-40] vs 32 [24-44] years, P<0.001), and less commonly insured by Medicare (6.5 vs 11.2%, P<0.001) compared to others. Those with recurrent stab wounds were younger (36 [27-49] vs 44 [30-57] years, P<0.001), less commonly insured by Medicare (21.3 vs 29.3%, P<0.001), and had lower Elixhauser Index Comorbidities score (2 [1-3] vs 3 [1-4], P<0.001) compared to others. After risk adjustment, RPI of both gunshot and stab was associated with significantly higher hospitalization costs, a shorter time before readmission, and increased odds of non-home discharge. CONCLUSION The trend in RPI has been on the rise for the past decade. National efforts to improve post-discharge prevention and social support services for patients with penetrating trauma are warranted and may reduce the burden of RPI.
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Affiliation(s)
- Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Russyan Mark Mabeza
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Syed Shahyan Bakhtiyar
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, University of Colorado, Aurora, CO, United States of America
| | - Shannon Richardson
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Zachary Tran
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
- Department of Surgery, Loma Linda University Health, Loma Linda, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
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Akbari J, Ghadami A, Taheri MR, Khosravi N, Zamani S. Safety and Health Management System, Safety Climate, and Accident Occurrences in Hospitals: The Study of Needlestick, Sharp Injuries and Recidivism Rates. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:550-558. [PMID: 37869695 PMCID: PMC10588921 DOI: 10.4103/ijnmr.ijnmr_431_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/21/2020] [Accepted: 06/08/2023] [Indexed: 10/24/2023]
Abstract
Background Hospital Safety and Health Management System (HSH-MS) and Hospital Safety Climate (HSC) are the significant elements to develop safe work practices. The current study aimed to examine the dimensions of HSH-MS and HSC and the association with the prevalence of Needlestick and Sharp Injury (NSI) and NSI recidivism. Materials and Methods A cross-sectional study was conducted among 1070 nurses in Iranian hospitals (89% response rate). Results More than 54% (n = 579) had sustained at least 1 NSI in the previous year. The NSI recidivism rate was 8.6% and recidivists were more likely to be younger, female, married, with higher Body Mass Index (BMI), and on night shift. Two aspects of HSH-MS including management leadership and employee participation were associated with the incidence of NSIs Odds Ratio (OR): 1.91 and 95% Confidence Interval (CI): 0.69-1.21; OR: 1.29 and 95% CI: 0.92-1.82) and NSI recidivism rate (OR: 1.98 and 95% CI: 0.55-1.74; OR: 1.12 and 95% CI: 0.83-1.49). Furthermore, three dimensions of HSC comprising management support (OR: 1.02 and 95% CI: 0.93-1.11 for NSIs; OR: 1.21 and 95% CI: 0.77-1.22 for NSI recidivism), absence of job hindrances (OR: 1.06 and 95% CI: 0.98-1.16 for NSIs; OR: 1.11 and 95% CI: 0.96-1.30 for NSI recidivism) and cleanliness/orderliness (OR: 1.07 and 95% CI: 0.98-1.08 for NSIs; OR: 0.84 and 95% CI: 0.87-0.97 for NSI recidivism) were correlated with reduced NSIs risk. Conclusions This study suggests that HSH-MSs and employees' safety climate are significant factors, which are correlated with not only the prevalence of recurrent NSIs but also the single NSI in hospitals.
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Affiliation(s)
- Jafar Akbari
- Centre for Work, Organisation and Wellbeing ( WOW), Griffith University, and Wellbeing, Griffith University, Nathan, QLD, Australia
| | - Ahmad Ghadami
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Taheri
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
| | - Nasrin Khosravi
- Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shirin Zamani
- Emam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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10
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Heimke IM, Connelly M, Clarke A, De Mario B, Breslin MA, Furdock R, Moore TA, Vallier HA. Recidivism after orthopaedic trauma has diminished over time. Eur J Trauma Emerg Surg 2023; 49:1891-1896. [PMID: 37162555 PMCID: PMC10170426 DOI: 10.1007/s00068-023-02274-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE The purpose was to analyze our trauma population during two periods to assess for predictors of recidivism. METHODS Prior (2007-2011, n = 879) and recent (2014-2019, n = 954) orthopaedic trauma patients were reviewed. Recidivists were those returning with an unrelated injury. Recidivism rates were compared, and factors associated with recidivism were identified. RESULTS Recidivism decreased: 18.7% to 14.3% (p = 0.01). Mean age and sex of the two cohorts were not different. Recent recidivists were more likely to sustain gunshot wound (GSW) injuries (22.1% vs 18.9%, p = 0.09), and mental illness was more common (56.6% vs 28.1%, p < 0.0001). The recent recidivist population was less often married (12.9% vs 23.8%, p = 0.03), and both recidivist groups were often underinsured (Medicaid or uninsured: (60.6% vs 67.0%)). CONCLUSION Recidivism diminished, although more GSW and mental illness were seen. Recidivists are likely to be underinsured. The changing profile of recidivists may be attributed to socioeconomic trends and new programs to improve outcomes after trauma.
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Affiliation(s)
- Isabella M Heimke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Madison Connelly
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Amelia Clarke
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Belinda De Mario
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Mary A Breslin
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Ryan Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Timothy A Moore
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH, 44109, USA.
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El-Menyar A, Goyal P, Samson D, Tilley E, Gashi S, Prabhakaran K, Latifi R. Risk factors and predictors of violence: insights from the emergency department at a level 1 trauma center in the USA. J Public Health (Oxf) 2023; 45:245-258. [PMID: 35166348 DOI: 10.1093/pubmed/fdac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the risk factors and predictors of violence among patients admitted to a Level 1 trauma center in a single institution. METHODS We conducted a retrospective analysis of patients who were admitted with a history of violence between 2012 and 2016. RESULTS A total of 9855 trauma patients were admitted, of whom 746 (7.6%) had a history of violence prior to the index admission. Patients who had history of violence were younger and more likely to be males, Black, Hispanic and covered by low-income primary payer in comparison to non-assault trauma patients (P < 0.001 for all). Multivariate logistic regression analysis showed that covariate-adjusted predictors of violence were being Black, male having low-income primary payer, Asian, drug user, alcohol intoxicated and smoker. CONCLUSIONS Violence is a major problem among young age subjects with certain demographic, social and ethnic characteristics. Trauma centers should establish violence injury prevention programs for youth and diverse communities.
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Affiliation(s)
- Ayman El-Menyar
- Department of Surgery, Clinical Research Trauma and Vascular Surgery at Hamad Medical corporation (P.O. Box 3050) & Clinical Medicine, Weill Cornell Medical School (P.O. Box 24144), Doha, Qatar
| | - Priya Goyal
- Department of Surgery, Clinical Research, Westchester Medical Center, Valhalla, NY 10595, USA
| | - David Samson
- Department of Surgery, Clinical Research, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Elizabeth Tilley
- New York City Health and Hospitals Corporation, North Central Bronx, NY 10467, USA
| | - Saranda Gashi
- Psychiatric Neuro Center, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY 11004, USA
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center & New York Medical College, Valhalla, NY 10595, USA
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Sigal A, Butts CA, Deaner T, Wasser T, Bailey B, Bindra M, Muller A, Martin AP, Ong A. Potentially Inappropriate Medications are Associated With Geriatric Trauma Recidivism. J Surg Res 2023; 283:581-585. [PMID: 36442257 DOI: 10.1016/j.jss.2022.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The American Geriatric Society has identified polypharmacy and categories of potentially inappropriate medication (PIM) that should be avoided in the elderly. These medications can potentially cause an increased risk of falls and traumatic events. MATERIALS AND METHODS We conducted a retrospective study on elderly patients with traumatic injuries at a Level 1 trauma center. We compared patients having only one traumatic event and those with one or more traumatic events with the presence of prescriptions for PIMs. RESULTS Identified high risk categories of anticoagulant and antiplatelet agents (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.08-1.28), psychiatric and neurologic agents (OR 1.32, 95% CI 1.22-1.43), as well as medication with anticholinergic properties (OR 1.14, 95% CI 1.03-1.27) were associated with an increased risk of recurrent trauma. CONCLUSIONS We can quantify the risk of recurrent trauma with certain categories of PIM. Medication reconciliation and shared decision-making regarding the continued use of these medications may positively impact trauma recidivism.
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Affiliation(s)
- Adam Sigal
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania.
| | - Christopher A Butts
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Traci Deaner
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Tom Wasser
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Blake Bailey
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Monisha Bindra
- Department of Emergency Medicine, Reading Hospital, West Reading, Pennsylvania
| | - Alison Muller
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Anthony P Martin
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
| | - Adrian Ong
- Division of Trauma, Acute Care and Surgical Critical Care, Department of Surgery, Reading Hospital, West Reading, Pennsylvania
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Heimke IM, Connelly M, Clarke A, DeMario B, Furdock R, Moore TA, Vallier HA. Trauma recidivism is pervasive and is associated with mental and social health opportunities. Injury 2023; 54:519-524. [PMID: 36372562 DOI: 10.1016/j.injury.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Recidivism after orthopedic trauma results in greater morbidity and costs. Prior studies explored the effects of social and medical factors affecting the frequency of return to the hospital with new, unrelated injury. Identification of mental, social and other risk factors for trauma recidivism may provide opportunities for mitigation. The purposes of this study are to determine the rates of subsequent, unrelated injury noted among orthopedic trauma patients at a large urban trauma center and to evaluate what patient and injury features are associated with greater rates of trauma recidivism. We hypothesize higher rates of new injuries will be related to ballistic trauma and other forms of assault, alcohol and recreational drug use, unemployment, and unmarried status among our trauma patients. METHODS A series of 954 skeletally mature patients at a level 1 trauma center over a 5 year period were included in the study. All were treated operatively for thoracolumbar, pelvic ring, acetabulum, and/or proximal or shaft femoral fractures from a high energy mechanism. Retrospective review of demographic, injury, medical, and social factors, and subsequent care was performed. Trauma recidivism was defined as returning to the emergency department for treatment of any new injury. A backward stepwise logistic regression statistical analysis was used to identify independent predictors of recidivism. RESULTS Mean age of all patients was 41.2 years, and 73.2% were male. 136 patients (14.3%) returned with a new injury within a mean of 21 months. These trauma recidivists were more likely to sustain a GSW (22.1% vs 11.4%, p = 0.001). They had higher rates of substance use, including tobacco (57.4% vs 41.8%, p = 0.001) and recreational drugs (50.7% vs 34.4%, p = 0.001), and were less likely to be married (10% vs 25.9%, p<0.001). Mental illness was pervasive, noted in 56.6% of patients with new injury (vs 32.8%, p<0.001). Medicaid insurance was most common in the trauma recidivist population (58.1% vs 35.0%, p = 0.001), and 12.5% were uninsured. Completing high school or more education was protective (93% non-recidivist (vs 79%, p = 0.001). Sixty-nine patients (50.7%) were repeat trauma recidivists within the study period. Independent predictors of new injury included recreational drug use (OR 1.64, p = 0.05) and history of assault due to GSW or other means (OR 1.67, p = 0.05). History of pre-existing mental illness represented the greatest risk factor for trauma recidivism (OR 2.55, p<0.001). DISCUSSION New injuries resulting in emergency department presentation after prior orthopedic trauma occurred in 14.3% and were associated with history of assault, lower education, Medicaid insurance, tobacco smoking and recreational drug use. Mental illness was the greatest risk factor. Over half of patients with these additional injuries were repeat trauma recidivists, returning for another new injury within less than 2 years. Awareness of risk factors may promote focused education and other interventions to mitigate this burden. LEVEL OF EVIDENCE Level 3 retrospective, prognostic.
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Affiliation(s)
- Isabella M Heimke
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Madison Connelly
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Amelia Clarke
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Belinda DeMario
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Ryan Furdock
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Timothy A Moore
- MetroHealth Medical Center, Case Western Reserve University School of Medicine
| | - Heather A Vallier
- MetroHealth Medical Center, Case Western Reserve University School of Medicine.
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Beyond Recidivism: Hospital-Based Violence Intervention and Early Health and Social Outcomes. J Am Coll Surg 2022; 235:927-939. [PMID: 36102509 DOI: 10.1097/xcs.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospital-based violence intervention programs (HVIPs) are aimed at decreasing recurrent injury and improving the social determinants of health. We hypothesized that the HVIP intervention should be evaluated by how well it can address the immediate health and social needs of patients after injury. Our study sought to describe the experience of our nascent HVIP. STUDY DESIGN Case management records of patients treated by the HVIP of a level 1 trauma center from July 1, 2017 to October 1, 2020 were reviewed. Inclusion criteria were as follows: age between 18 and 60 with injury mechanisms that resulted from intentional violence. Patient-stated goals and social worker designation of patient services provided were analyzed. A subset of HVIP patients who completed the three planned study visit surveys at discharge and 1 and 3 months were compared with a cohort of violently injured patients to whom HVIP services were not available. Participants in both groups were asked to complete a battery of validated surveys to assess social outcomes and post-traumatic stress disorder (PTSD). Repeated-measures ANOVA was used to compare the two groups. RESULTS Two hundred and ninety-five patients met the inclusion criteria. One hundred and forty-six patients (49%) achieved their stated goals within 6 months of hospital discharge. Sixteen patients who achieved their stated goals disengaged from the program. Engagement in the HVIP resulted in significantly less PTSD at the time of hospital discharge. HVIP patients also experienced higher positive affect at hospital discharge, as described in the Positive and Negative Affect Schedule. HVIP participants were significantly more likely to achieve early positive health outcomes, such as completion of victim of crime compensation and return to school. CONCLUSIONS Our HVIP successfully achieved patient-stated short-term health and social goals in nearly half of all enrollees, indicating that HVIP patients are more likely to improve their social determinants of health than non-HVIP patients. Short-term health and social outcomes were improved in HVIP patients compared with non-HVIP patients, indicating increased engagement with the healthcare system. We suggest that these outcomes should replace recidivism as a metric for the efficacy of HVIP programs.
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Harry ML, Lake E, Woehrle TA, Heger AMC, Vogel LE. Implementing a Screening and Brief Intervention Protocol for Excessive Alcohol Use in a Trauma Center: A Healthcare Improvement Project. J Addict Nurs 2022; 33:247-254. [PMID: 37140412 DOI: 10.1097/jan.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE The aim of this healthcare improvement project was to evaluate healthcare provider use of screening and brief interventions (SBIs) for patients screening positive for alcohol at an upper Midwestern adult trauma center transitioning from Level II to Level I. METHOD Trauma registry data for 2,112 adult patients with trauma who screened positive for alcohol were compared between three periods: pre-formal-SBI protocol (January 1, 2010, to November 29, 2011); first post-SBI protocol (February 6, 2012, to April 17, 2016) after protocol implementation, healthcare provider training, and documentation changes; and second post-SBI protocol (June 1, 2016, to June, 30, 2019) after additional training and process improvements. Data analysis included descriptive statistics and logistic regression for comparisons over time and between admitting services. RESULTS For the trauma admitting service, SBI rates increased from 32% to 90% over time, compared with 18%-51% for other admitting services combined. Trauma-service-admitted patients screening positive for alcohol had higher odds of receiving a brief intervention than other admitting services in each period in adjusted models: pre-SBI (OR = 1.99, 95% CI [1.15, 3.43], p = .014), first post-SBI (OR = 2.89, 95% CI [2.04, 4.11], p < .001), and second post-SBI (OR = 11.40, 95% CI [6.27, 20.75], p < .001) protocol periods. Within trauma service admissions, first post-SBI protocol (OR = 2.15, 95% CI [1.64, 2.82], p < .001) and second post-SBI protocol (OR = 21.56, 95% CI [14.61, 31.81], p < .001) periods had higher rates and odds of receiving an SBI than the pre-SBI protocol period. CONCLUSION The number of SBIs completed with alcohol-positive adult patients with trauma significantly increased over time through SBI protocol implementation, healthcare provider training, and process improvements, suggesting other admitting services with lower SBI rates could adopt similar approaches.
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Beiter K, Danos D, Conrad E, Broyles S, Zabaleta J, Mussell J, Phillippi S. PTSD treatment reduces risk of trauma recidivism in a diverse community at a safety-net hospital: A propensity score analysis of data from a level one trauma center. Injury 2022; 53:2493-2500. [PMID: 35641330 PMCID: PMC11036415 DOI: 10.1016/j.injury.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Physically-traumatic injuries result in PTSD for approximately 10% of Americans, and this rate is higher among individuals of color and those living in poverty. Individuals of color living in poverty experience lower access to PTSD and other mental health services. Untreated PTSD is associated with increased risk of trauma recidivism, but it is unknown if provision of treatment is actually associated with a subsequent reduction in recidivism risk. METHODS For this observational cross-sectional study, data were collected retrospectively from the Trauma Registry of a level one trauma center, safety-net hospital in New Orleans between 2018 and 2020. Receipt of outpatient PTSD treatment at this same hospital was evaluated via chart review of the electronic health record. Propensity score matching was used to balance confounding variables of trauma type (assault vs. non-assault), gender, and race. McNemar test and Cox proportional hazard model were used with the propensity-balanced dataset to assess differences in trauma recidivism according to PTSD treatment status. RESULTS Among 5916 trauma activations that occurred in the study period, 92 instances of recidivism occurred. 91 pairs were established after balancing with the propensity score. 1-year recidivism was 2.2% (n = 2) of all treated individuals versus 15.4% (n = 14) of non-treated individuals (p < 0.0001). The marginal risk from the Cox proportional hazard model demonstrated an 82% reduction in risk of recidivism (p = 0.02). CONCLUSIONS This study demonstrated that mental health treatment can be used to reduce trauma recidivism. These data were shown among a high-risk population of disproportionately Black men living in a low-income community. Ensuring access to quality mental health care is one way to address the health disparities associated with physically-traumatic injuries.
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Affiliation(s)
- Kaylin Beiter
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States.
| | - Denise Danos
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
| | - Erich Conrad
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
| | - Stephanie Broyles
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
| | - Jovanny Zabaleta
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
| | - Jason Mussell
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
| | - Stephen Phillippi
- Department of Behavioral and Community Health Sciences, Louisiana State University Health Sciences Center, 2020 Gravier Street, Floor 3, New Orleans LA 70112, United States
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Bryant MK, Aubry S, Schiro S, Raff L, Perez AJ, Reid T, Maine RG. Causes of death following discharge after trauma in North Carolina. J Trauma Acute Care Surg 2022; 92:371-379. [PMID: 34789699 DOI: 10.1097/ta.0000000000003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While a "fourth peak" of delayed trauma mortality has been described, limited data describe the causes of death (CODs) for patients in the years following an injury. This study investigates the difference in COD statewide for patients with and without a recent trauma admission. METHODS This retrospective cohort study compared COD for trauma and nontrauma patients in North Carolina. Death certificates in NC's death registry were matched with the NC trauma registry between January 2013 and December 2018 using matching on name and date of birth. Patients who died during the index trauma admission were excluded. Underlying COD recorded on the death certificate were used for the primary analysis. RESULTS Of 481,415 death records, 19,083 (4.0%) were linked to an alive discharge within the trauma registry during the study period. Prior trauma patients (PTPs) had a higher incidence of mental illness (9.2 vs. 6.1%), Alzheimer's (6.1% vs. 4.2%), and opioid-related (1.8% vs. 1.6%) COD compared to nontrauma patients, p < 0.05. Overall, suicide was higher in the nontrauma cohort (1.5% vs. 1.1%); however, PTP had higher incidences of death by motor vehicle collision and other injury (6.0% vs. 3.8%) and homicide (0.9% vs. 0.6%), p < 0.001. Prior trauma patients had 1.16 increased odds of an opioid-related death (p = 0.009; 95% confidence interval, 1.04-1.29) compared with those without prior trauma. Younger PTP had a much higher rate of death from suicide (12.0%) compared with those 41 to 65 years (2.8%) and older than 65 years (0.2%; p < 0.001). Discharge to skilled nursing facility (odds ratio, 1.87; p < 0.05) and severe injury (odds ratio, 1.93; p < 0.05) were associated with early death after discharge (≤90 days). CONCLUSION After hospital discharge, PTPs remain at risk of dying from future trauma and opioid-related conditions. Prevention strategies for PTP should address the increased risk of death from a subsequent traumatic injury and the at-risk populations for early death after discharge. LEVEL OF EVIDENCE Prognostic and Epidemiologic, Level IV.
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Affiliation(s)
- Mary K Bryant
- From the Department of Surgery (M.K.B., S.A., S.S., L.R., A.J.P., T.R.), University of North Carolina, Chapel Hill; Department of General Surgery/Trauma (M.K.B.), WakeMed Health & Hospitals, Raleigh, North Carolina; and Department of Surgery (R.G.M.), University of Washington, Seattle, Washington
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Abraham PJ, Abraham MN, Griffin RL, Tanner L, Jansen JO. Evaluation of Injury Recidivism Using the Electronic Medical Record. J Surg Res 2021; 267:217-223. [PMID: 34153565 DOI: 10.1016/j.jss.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/18/2022]
Abstract
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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Affiliation(s)
- Peter J Abraham
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | | | - Russell L Griffin
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Lauren Tanner
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Jan O Jansen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.
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Abstract
BACKGROUND Blood-borne pathogen infections (BPIs), caused by the human immunodeficiency virus, hepatitis C and hepatitis B viruses pose an occupational hazard to healthcare workers. Facial trauma reconstruction surgeons may be at elevated risk because of routine use of sharps, and a higher than average incidence of BPIs in the trauma patient population. METHODS The authors retrospectively reviewed health records of patients admitted to a level 1 trauma center with a facial fracture between January 2010 and December 2015. Patient demographics, medical history, mechanism of injury, type of fracture, and procedures performed were documented. The authors detemined the frequency of human immunodeficiency virus, hepatitis B, and hepatitis C diagnosis and utilized univariable/multivariable analyses to identify risk factors associated with infection in this population. RESULTS In total, 4608 consecutive patients were included. Infections were found in 4.8% (n = 219) of patients (human immunodeficiency virus 1.6%, hepatitis C 3.3%, hepatitis B 0.8%). 76.3% of BPI patients in this cohort were identified by medical history, while 23.7% were diagnosed by serology following initiation of care. 39.0% of all patients received surgical treatment during initial hospitalization, of whom 4.3% had a diagnosed BPI. History of intravenous drug use (odds ratio [OR] 6.79, P < 0.001), assault-related injury (OR 1.61, P = 0.003), positive toxicology screen (OR 1.56, P = 0.004), and male gender (OR 1.53, P = 0.037) were significantly associated with a BPI diagnosis. CONCLUSION Patients presenting with facial fractures commonly harbor a BPI. The benefit of early diagnosis and risk to surgical staff may justify routine screening for BPI in high risk facial trauma patients (male, assault-related injury, and history of intravenous drug use).
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Strong BL. Diversity, equity and inclusion in acute care surgery: a multifaceted approach. Trauma Surg Acute Care Open 2021; 6:e000647. [PMID: 33905463 PMCID: PMC8016078 DOI: 10.1136/tsaco-2020-000647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/02/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Bethany L Strong
- Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA
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21
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Recidivism rates following firearm injury as determined by a collaborative hospital and law enforcement database. J Trauma Acute Care Surg 2020; 89:371-376. [PMID: 32345906 DOI: 10.1097/ta.0000000000002746] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recidivism is a key outcome measure for injury prevention programs. Firearm injury recidivism rates are difficult to determine because of poor longitudinal follow-up and incomplete, disparate databases. Reported recidivism rates from trauma registries are 2% to 3%. We created a collaborative database merging law enforcement, emergency department, and inpatient trauma registry data to more accurately determine rates of recidivism in patients presenting to our trauma center following firearm injury. METHODS A collaborative database for Jefferson County, Kentucky, was constructed to include violent firearm injuries encountered by the trauma center or law enforcement from 2008 to 2019. Iterative deterministic data linkage was used to create the database and eliminate redundancies. From patients with at least one hospital encounter, raw recidivism rates were calculated by dividing the number of patients injured at least twice by the total number of patients. Cox proportional hazard models were used to evaluate risk factors for recidivism. The cumulative incidence of recidivism over time was estimated using a Kaplan-Meier survival model. RESULTS There were 2, 363 assault-type firearm injuries with at least 1 hospital encounter, approximately 9% of which did not survive their initial encounter. The collaborative database demonstrated raw recidivism rates for assault-type firearm injuries of 9.5% compared with 2.5% from the trauma registry alone. Risk factors were young age, male sex, and African American race. The predicted incidence of recidivism was 3.6%, 5.6%, 11.4%, and 15.8% at 1, 2, 5, and 10 years, respectively. CONCLUSION Both hospital and law enforcement data are critical for determining reinjury rates in patients treated at trauma centers. Recidivism rates following violent firearm injury are four times higher using a collaborative database compared with the inpatient trauma registry alone. Predicted incidence of recidivism at 10 years was at least 16% for all patients, with high-risk subgroups experiencing rates as high as 26%. LEVEL OF EVIDENCE Epidemiological, level III.
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22
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Bryant MK, Reynolds K, Brittain C, Patel Z, Reid TDS, Maine RG, Udekwu P. Does Level of Blood Alcohol Content Affect Clinical Outcomes After Trauma in Older Adult Patients? Am Surg 2020; 86:1106-1112. [PMID: 32967437 DOI: 10.1177/0003134820943555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Preinjury alcohol use and older age have independently been associated with poor outcomes. This study examined whether higher levels of blood alcohol concentration (BAC) correlated with an increased likelihood of poor outcomes in older trauma patients. METHODS This was a retrospective cohort study of injured patients ≥65 years with BAC testing presenting to a Level 1 trauma center between 2015 and 2018. Patients were stratified by BAC at 4 thresholds of intoxication: BAC ≧10 mg/dL, BAC ≧80 mg/dL, BAC ≧150 mg/dL, and BAC ≧200 mg/dL. Propensity score matching using inverse probability of treatment weighting was used to estimate outcomes. Logistic and Poisson regression models were performed for each threshold of the BAC level with the matched cohort to assess clinical outcomes. RESULTS Of all older patients (n = 3112), 32.5% (n = 1012) had BAC testing. In the matched cohort of 883 patients (76.7 ± 8.2 years; 48.1% female), 111 (12.5%) had BAC ≧10 mg/dL, 83 (74.8%) had BAC ≧80 mg/dL, 60 (54.1%) had BAC ≧150 mg/dL, and 37 (33.3%) had BAC ≧200 mg/dL. Falls (60.5%) and motor vehicle crashes (28.9%) were the most common mechanisms of injury. Median (IQR) of Injury Severity Score (ISS) was 5 (1-10). The risk of severe injury (ISS ≧15) was similar between alcohol-positive and alcohol-negative patients (9.9% vs 15.0%, P = .151). BAC ≧10 g/dL was not associated with length of stay, intensive care unit admission, or in-hospital complication, nor was any of the other 3 analyzed BAC thresholds. CONCLUSION Overall, any detectable BAC along and increasing thresholds of BAC was not associated with poor in-hospital outcomes of older patients after trauma. Alcohol screening was low in this population, and intoxication may bias injury assessment, leading to mistriage of older trauma patients.
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Affiliation(s)
- Mary K Bryant
- Department of Surgery, WakeMed Health & Hospitals, Raleigh, NC, USA.,6798 Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | | | - Connor Brittain
- Department of Surgery, WakeMed Health & Hospitals, Raleigh, NC, USA
| | - Zachery Patel
- Department of Surgery, WakeMed Health & Hospitals, Raleigh, NC, USA
| | - Trista D S Reid
- 6798 Department of Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Rebecca G Maine
- 7284 Department of Surgery, University of Washington, Seattle, WA, USA
| | - Pascal Udekwu
- Department of Surgery, WakeMed Health & Hospitals, Raleigh, NC, USA
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Recidivism at the puerto rico trauma hospital. Eur J Trauma Emerg Surg 2020; 48:891-900. [PMID: 32945895 PMCID: PMC9001212 DOI: 10.1007/s00068-020-01487-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/04/2020] [Indexed: 11/25/2022]
Abstract
Purpose Although 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. Methods An 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. Results 24,650 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 \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 25 [adjusted odds ratio (AOR) = 0.44; 95% CI: 0.28–0.68] and a GCS \documentclass[12pt]{minimal}
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\begin{document}$$\le$$\end{document}≤ 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 \documentclass[12pt]{minimal}
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\begin{document}$$\ge$$\end{document}≥ 25 increased (7.9% vs. 14.1%; p = 0.022). Conclusion The 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.
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Bonne S, Tufariello A, Coles Z, Hohl B, Ostermann M, Boxer P, Sloan-Power E, Gusmano M, Glass NE, Kunac A, Livingston D. Identifying participants for inclusion in hospital-based violence intervention: An analysis of 18 years of urban firearm recidivism. J Trauma Acute Care Surg 2020; 89:68-73. [PMID: 32574483 DOI: 10.1097/ta.0000000000002680] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Identifying individuals at highest risk maximizes efficacy of prevention programs in decreasing recidivist gunshot wound (GSW) injury. Characteristics of GSW recidivists may identify this population. Hospital-based violence intervention programs (HVIPs) are one effective strategy; however, programs are expensive, therefore, when possible, epidemiologic data should guide inclusion criteria. METHODS Seventeen years of all GSW patients presenting to an urban Level I trauma center were reviewed. Countywide murders were reviewed from the same timeframe. Recidivists were any patient presenting twice, either to the hospital or once to the hospital and subsequently dying by firearm. Demographics and characteristics of future recidivists were compared with nonfuture recidivists. RESULTS There were 9,699 unique intentional, GSW cases reviewed and 1,426 died, leaving 8,273 at risk of recidivism. Five hundred fourteen (6.2%) became recidivists. Most recidivists were African-American men and were younger at first GSW. Median time between incidents was 2.5 years, with a range of 0 days to 16 years. Nearly half were treated and released from the emergency department at their first episode of GSW. For recidivists who died, 128 died at the second incident, 29 at later incidents. Mortality from a second incident of firearm injury is 10% higher than first injuries, second hospitalizations are US $5,000 more expensive, and loss of life has a societal cost of US $167 billion in this community alone. CONCLUSION The most appropriate population for inclusion in HVIPs at our hospital are young black men. The HVIP services are needed in the emergency department to address those treated and released at first GSW. Recidivists have higher mortality, and hospitalizations are significantly more expensive at the second injury. The investment in prevention is justified and may lead to a decrease in recidivism. LEVEL OF EVIDENCE Therapeutic/Care Management level III.
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Affiliation(s)
- Stephanie Bonne
- From the Division of Trauma and Critical Care, Department of Surgery, Rutgers New Jersey Medical School (S.B., A.T., N.E.G., A.K., D.L.); Rutgers Graduate School of Biomedical Sciences (Z.C.), Newark; Department of Epidemiology (B.H.), Rutgers School of Public Health, Piscataway; Rutgers School of Criminal Justice (M.O.); Department of Psychology (P.B.), Department of Social Work (E.S-P.), Rutgers-Newark School of Arts and Sciences, Newark; Department of Health Behavior, Society and Policy (M.G.), Rutgers School of Public Health, Piscataway; and The New Jersey Center on Gun Violence Research at Rutgers (S.B., B.H., M.O., P.B., E.S-P., M.G.), Newark, New Jersey
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National Estimates and Factors Influencing Trauma Recidivism in Children Leading to Hospital Readmission. J Pediatr Surg 2020; 55:1579-1584. [PMID: 31759651 DOI: 10.1016/j.jpedsurg.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 07/26/2019] [Accepted: 10/02/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Trauma is the leading cause of mortality in children. Factors influencing recidivism after major trauma have not been well documented in children. The objective of this study is to determine the burden of pediatric trauma recidivism and to identify predisposing factors in the United States. METHODS The 2010-2015 National Readmissions Database was queried for pediatric patients (≤18 years) with a diagnosis of major traumatic injuries. Patients readmitted for major trauma were subsequently identified. Patients that did not survive their index-hospitalization were excluded. Information on mechanism, intent, nature and injury severity including Abbreviated Injury Scale (AIS) and Injury Severity Scores (ISS) was obtained. Multivariable-regression analyses were performed adjusting for demographic, hospital-level and injury characteristics. RESULTS Of 286,508 pediatric trauma records analyzed, trauma recidivists represented 2.9% of the total population. Recidivists had a higher proportion of severe (AIS ≥ 3) head injury (11.3%). Recidivists were more likely to have public-insurance (OR [95% CI]:1.30[1.25-1.37]), and belong to lower income families (OR [95% CI]:1.22[1.15-1.31]). Recidivism was more common amongst patients with penetrating injuries (OR [95% CI]:2.12[1.96-2.28]). The risk adjusted cost of readmission for trauma was $8401[95% CI: 6748-10,053] higher compared to the index hospitalization with a total increased cost of 11.5 million USD annually. CONCLUSION Although not common, recidivism after major trauma remains a significant public-health concern. This study gauges the previously unquantified burden of recidivism amongst children and identifies factors predisposing to recurrent trauma. LEVEL OF EVIDENCE III TYPE OF EVIDENCE: Case control study.
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Trauma Recidivism Postdischarge Mortality: Important Differences Exist between the Adult and Geriatric Populations. Am Surg 2020. [DOI: 10.1177/000313481908500723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma recidivists are a high-risk patient population. The effects of recidivism on Geriatric trauma mortality have not been investigated. Our hypothesis is that trauma recidivism is associated with high postdischarge mortality after the initial index admission in both the geriatric and adult trauma populations. The trauma registry of our Level I trauma center was queried for patients evaluated between 2008 and 2012. Patients were stratified adult (18–64) and geriatric (≥65) groups and matched with mortality data from the National Death Index. Unique patients were identified and recidivists flagged. Statistical analysis was performed based on characteristics from the index admission using nonparametric tests, and Kaplan–Meier curves were plotted to examine postdischarge mortality after index admission for recidivists. A total of 8716 records met inclusion criteria; 800 recidivist records were identified representing 369 unique patients. Recidivists presented between 2 and 7 times. Recidivists were more likely to be male, required ICU admission and mechanical ventilation, had a longer median length of stay, were less likely to discharge home, and had a higher postdischarge mortality. Stratifying into adult and geriatric groups demonstrated significant differences in injury severity, injury patterns, length of stay, race, gender, mechanism, and postdischarge mortality. Recidivists demonstrated a higher postdischarge mortality in both groups with the geriatric group approaching 46 per cent. Trauma recidivists represent an at-risk group with significantly higher postdischarge mortality. Group characteristics differ significantly between the adult and geriatric recidivist populations. Further research is needed to identify modifiable risk factors in these populations to minimize risks of morbidity and mortality.
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Lim KHA, McDermott K, Read DJ. Interpersonal violence and violent re-injury in the Northern Territory. Aust J Rural Health 2020; 28:67-73. [PMID: 31970833 DOI: 10.1111/ajr.12590] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/12/2019] [Accepted: 10/14/2019] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To analyse incidence of prior emergency department presentations for interpersonal violence and demographics for a series of hospital admissions for interpersonal violence injuries. DESIGN Retrospective analysis of trauma registry. SETTING A tertiary hospital and primary referral centre for trauma in the Top End of the Northern Territory. PARTICIPANTS Patients hospitalised from 2010 to 2015 for injuries due to interpersonal violence with an injury severity score > 9. MAIN OUTCOME MEASURES Patient demographics, injury location, assault mechanism, alleged perpetrator, time/day of event, alcohol involvement, clinical outcome and prior emergency department presentations for interpersonal violence. RESULTS A total of 248 admissions for patients with Injury Severity Score > 9 due to interpersonal violence were identified. Indigenous females over-represented non-Indigenous females (35.4% vs 5.0%, P < .001). The majority of victims had evidence of alcohol intake at presentation. Victims of single-punch head injuries were mostly male and non-Indigenous, whilst Indigenous persons experienced significantly more blunt and penetrating weapon injuries (66.7% and 68.1%). Forty-three per cent of patients had a preceding emergency department presentation for interpersonal violence; female gender, Indigenous ethnicity, evidence of alcohol intake, and urban location of injury were independent risk factors for prior interpersonal violence presentation. CONCLUSIONS Interpersonal violence is a recurring disease for a just under half of those presenting to a Top End hospital with moderate to severe injuries. Indigenous ethnicity, female gender and evidence of alcohol intake are predictive of prior interpersonal violence presentations. Patient under-reporting and incomplete data may underestimate the true prevalence of interpersonal violence presentations in rural and remote locales.
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Affiliation(s)
| | - Kathleen McDermott
- National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
| | - David J Read
- Royal Darwin Hospital, Casuarina, Northern Territory, Australia.,National Critical Care and Trauma Response Centre, Darwin, Northern Territory, Australia
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Cirone J, Bendix P, An G. A System Dynamics Model of Violent Trauma and the Role of Violence Intervention Programs. J Surg Res 2019; 247:258-263. [PMID: 31706544 DOI: 10.1016/j.jss.2019.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/26/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Violence intervention programs (VIPs) can reduce interpersonal violence (IPV); however, optimizing the implementation of VIPs is challenging, given the complex dynamics of IPV. System dynamics models (SDMs) provide a means of visualizing dynamic and causal relationships in such complex systems. We use the IPVSDM to characterize and examine the relationship between IPV, VIPs, and the social determinants of health (SDH). MATERIALS AND METHODS The simulation model was created from a diagram that links putative causal relationships between VIPs, SDH, and IPV events. Simulation rules are then used to calculate a risk of violence parameter based on the SDH, which drives the transition from low-risk to high-risk populations and in turn influences IPV event rates. A qualitative relational approach was used to evaluate long-term effects of VIP on IPV events. RESULTS The model produced qualitatively plausible behavior with respect to IPV events, population transitions, and relative overall VIP effect. Simulation runs converged to stable steady states with an exponential benefit of VIP on reducing IPV that is best appreciated after 1-2 y. The VIP functioned in a recognizable fashion by slowing the shift from low-risk to high-risk populations. CONCLUSIONS This initial implementation of the IPVSDM produced recognizable baseline behavior while incorporating the possible effects of a VIP. The model allows causality and counterfactual testing, which is impractical in vivo. Community-level VIP efforts should show benefit particularly after a couple years. Future work will emphasize adding complexity to the IPVSDM and identifying real-world metrics to aid in testing, validation, and prediction of the model.
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Affiliation(s)
- Justin Cirone
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Peter Bendix
- Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Gary An
- Department of Surgery, The University of Vermont, Burlington, Vermont.
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Albrecht JS, Al Kibria GM, Greene CR, Dischinger P, Ryb GE. Post-Discharge Mortality of Older Adults with Traumatic Brain Injury or Other Trauma. J Am Geriatr Soc 2019; 67:2382-2386. [PMID: 31343731 DOI: 10.1111/jgs.16098] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Prior studies of mortality following traumatic brain injury (TBI) have not focused specifically on older adults compared with a non-TBI trauma cohort or included specific causes of death. The objectives of this study were, among adults aged 65 years and older, to (1) generate standardized mortality ratios (SMRs) by cause of death for TBI and a non-TBI trauma cohort compared with a general population, and (2) assess risk of mortality associated with TBI compared with a non-TBI trauma cohort. DESIGN Retrospective cohort study of adults aged 65 years and older who were treated at an urban trauma center from 1997 to 2008. MEASUREMENTS Data from the trauma registry were linked to the National Death Index through 2008 to obtain date and cause of death. We identified individuals with TBI and non-TBI trauma and calculated age- and sex-adjusted SMRs by comparing with the state general population. We next compared time to mortality between individuals with TBI (n = 852) and non-TBI trauma (n = 1050), adjusting for potential confounders. RESULTS Compared with the age- and sex-adjusted state general population, older adults with TBI (SMR = 8.1; 95% confidence interval [CI] = 7.4-9.0) and non-TBI trauma (SMR = 6.7; 95% CI = 6.1-7.4) were at a greatly increased risk of mortality. Highest SMRs in both cohorts were observed for accidents. In adjusted Cox regression models, TBI was not associated with increased risk of all-cause mortality (hazard ratio = 1.03; 95% CI = .87-1.23) compared with non-TBI trauma. CONCLUSION This study provides evidence that, over a 4-year follow-up of older adults, any moderate to severe injury is associated with increased mortality risk. Specifically, older injured adults are at high risk of death from accidental and therefore preventable causes, suggesting that intervention could reduce mortality. J Am Geriatr Soc 67:2382-2386, 2019.
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Affiliation(s)
- Jennifer S Albrecht
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gulam Muhammed Al Kibria
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Christina R Greene
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Patricia Dischinger
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Gabriel E Ryb
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland.,Trauma Service, University of Maryland Prince George's Hospital Medical Center, Cheverly, Maryland
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Kao AM, Schlosser KA, Arnold MR, Kasten KR, Colavita PD, Davis BR, Sing RF, Heniford BT. Trauma Recidivism and Mortality Following Violent Injuries in Young Adults. J Surg Res 2019; 237:140-147. [DOI: 10.1016/j.jss.2018.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/16/2018] [Accepted: 09/04/2018] [Indexed: 11/15/2022]
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Laughon SL, Gaynes BN, Chrisco LP, Jones SW, Williams FN, Cairns BA, Gala GJ. Burn recidivism: a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States. BURNS & TRAUMA 2019; 7:9. [PMID: 30923714 PMCID: PMC6423767 DOI: 10.1186/s41038-019-0145-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 02/12/2019] [Indexed: 11/30/2022]
Abstract
Background Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma, known as trauma recidivism. The epidemiology of burn recidivism, specifically, has not been described. This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists (RCs) with non-recidivists (NRCs). Methods A 10-year retrospective descriptive cohort study of adult burn patients admitted to the North Carolina Jaycee Burn Center was conducted using data from an electronic burn registry and the medical record. Continuous variables were reported using medians and interquartile ranges (IQR). Chi-square and Wilcoxon-Mann-Whitney tests were used to compare demographic, burn, and hospitalization characteristics between NRCs and RCs. Results A total of 7134 burn patients were admitted, among which 51 (0.7%) were RCs and accounted for 129 (1.8%) admissions. Of the 51 RCs, 37 had two burn injuries each, totaling 74 admissions as a group, while the remaining 14 RCs had between three and eight burn injuries each, totaling 55 admissions as a group. Compared to NRCs, RCs were younger (median age 36 years vs. 42 years, p = 0.02) and more likely to be white (75% vs. 60%, p = 0.03), uninsured (45% vs. 30%, p = 0.02), have chemical burns (16% vs. 5%, p < 0.0001), and have burns that were ≤ 10% total body surface area (89% vs. 76%, p = 0.001). The mortality rate for RCs vs. NRCs did not differ (0% vs. 1.2%, p = 0.41). Psychiatric and substance use disorders were approximately five times greater among RCs compared to NRCs (75% vs. 15%, p < 0.001). Median total hospital charges per patient were nearly three times higher for RCs vs. NRCs ($85,736 vs. $32,023, p < 0.0001). Conclusions Distinct from trauma recidivism, burn recidivism is not associated with more severe injury or increased mortality. Similar to trauma recidivists, but to a greater extent, burn RCs have high rates of comorbid psychiatric and medical conditions that contribute to increased health care utilization and costs. Studies involving larger samples from multiple centers can further clarify whether these findings are generalizable to national burn and trauma populations.
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Affiliation(s)
- Sarah L Laughon
- 1Department of Psychiatry, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160 USA
| | - Bradley N Gaynes
- 1Department of Psychiatry, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160 USA
| | - Lori P Chrisco
- Department of Surgery, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050 USA
| | - Samuel W Jones
- Department of Surgery, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050 USA.,North Carolina Jaycee Burn Center, 101 Manning Drive, CB #7206, Chapel Hill, NC 27599-7600 USA
| | - Felicia N Williams
- Department of Surgery, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050 USA.,North Carolina Jaycee Burn Center, 101 Manning Drive, CB #7206, Chapel Hill, NC 27599-7600 USA
| | - Bruce A Cairns
- Department of Surgery, 4001 Burnett-Womack Building, CB #7050, Chapel Hill, NC 27599-7050 USA.,North Carolina Jaycee Burn Center, 101 Manning Drive, CB #7206, Chapel Hill, NC 27599-7600 USA
| | - Gary J Gala
- 1Department of Psychiatry, 101 Manning Drive, CB #7160, Chapel Hill, NC 27599-7160 USA
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Abstract
OBJECTIVES To determine the rate of recurrent major trauma (i.e., trauma recidivism) using a provincial population-based trauma registry. We compared outcomes between recidivists and non-recidivists, and assessed factors associated with recidivism and mortality. METHODS Review of all adult (>17 years) major trauma patients in Nova Scotia (2001-2015) using data from the Nova Scotia Trauma Registry. Outcomes of interest were mortality, duration of hospital stay, and in-hospital complications. Multiple regression was used to assess factors associated with recidivism and mortality. RESULTS Of 9,365 major trauma patients, 2% (150/9365) were recidivists. Mean age at initial injury was 52 ± 21.5 years; 73% were male. The mortality rate for both recidivists and non-recidivists was 31%. However, after adjusting for potential confounders the likelihood of mortality was over 3 times greater for recidivists compared to non-recidivists (OR 3.67, 95% CI 2.06-6.54). Other factors associated with mortality included age, male gender, penetrating injury, Injury Severity Score, trauma team activation (TTA) and admission to the intensive care unit. The only variables associated with recidivism were age (OR 0.98, 95% CI 0.97-1.00) and TTA (OR 0.59, 95% CI 0.34-0.96). CONCLUSIONS This is the first provincial investigation of major trauma recidivism in Canada. While recidivism was infrequent (2%), the adjusted odds of mortality were over three times greater for recidivists. Further research is warranted to determine the effectiveness of strategies for reducing rates of major trauma recidivism such as screening and brief intervention in cases of violence or substance abuse.
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de Anda H, Dibble T, Schlaepfer C, Foraker R, Mueller K. A Cross-Sectional Study of Firearm Injuries in Emergency Department Patients. MISSOURI MEDICINE 2018; 115:456-462. [PMID: 30385996 PMCID: PMC6205282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED This is a single-center cross-sectional study of consecutive patients who presented to an urban emergency department (ED) with firearm injuries between July 1, 2014 and June 30, 2016. The objective of this study was to describe the characteristics of patients in this cohort and identify those at risk of firearm re-injury to inform future interventions. Patients in this cohort with both initial and recidivistic firearm injures were found to be predominately young, African American men. OBJECTIVE To describe the characteristics of patients who present to the emergency department (ED) with firearm injuries and identify those at risk of firearm re-injury. METHODS This is a single-center cross-sectional study of consecutive patients who presented to the ED with firearm injuries between July 1, 2014 and June 30, 2016. We collected data on patient demographics, history of previous traumatic injury including firearm injury, and whether the firearm injury was self-inflicted. We also evaluated characteristics of patients in this cohort who returned to the ED with firearm re-injury within a one year follow-up period. RESULTS This study included 1226 unique patients. Our data demonstrate that patients presenting to the ED for firearm injury were predominately young, African American males. Fourteen percent had a history of a previous firearm injury and 20% had a history of other non-firearm assault. Patients who had been shot previously were more likely to be African American, male, uninsured, unemployed, and have a history of other non-accidental trauma. Eight percent of firearm injuries were self-inflicted. All 35 patients who sustained a new firearm injury within 1 year of the index injury were African American males with a median age of 23. CONCLUSIONS Among patients treated in the ED for firearm injuries, young, African American males are disproportionately at risk of firearm injury and re-injury. ED visits for traumatic injury represent an opportunity to provide social work, case work, and counseling-based interventions to help disrupt the cycle of violence in high-risk individuals.
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Affiliation(s)
- Heather de Anda
- Heather de Anda, MD, Taylor Dibble, Charles Schlaepfer, Randi Foraker, PhD, and Kristen Mueller, MD, are affiliated with the Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - Taylor Dibble
- Heather de Anda, MD, Taylor Dibble, Charles Schlaepfer, Randi Foraker, PhD, and Kristen Mueller, MD, are affiliated with the Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - Charles Schlaepfer
- Heather de Anda, MD, Taylor Dibble, Charles Schlaepfer, Randi Foraker, PhD, and Kristen Mueller, MD, are affiliated with the Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - Randi Foraker
- Heather de Anda, MD, Taylor Dibble, Charles Schlaepfer, Randi Foraker, PhD, and Kristen Mueller, MD, are affiliated with the Washington University in Saint Louis School of Medicine, St. Louis, Missouri
| | - Kristen Mueller
- Heather de Anda, MD, Taylor Dibble, Charles Schlaepfer, Randi Foraker, PhD, and Kristen Mueller, MD, are affiliated with the Washington University in Saint Louis School of Medicine, St. Louis, Missouri
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Fernández Mondéjar E, Guerrero López F, Cordovilla Guardia S. Paciente traumatizado recuperado: buena suerte y… ¡hasta la próxima! Med Intensiva 2018; 42:205-206. [DOI: 10.1016/j.medin.2017.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
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