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Conrad EJ, Rajo EM, Barker C, Beiter K, Hughes JB, Stuart S. The Trauma Recovery Clinic: A Stepped Collaborative Care Model for Trauma Surgery Patients to Address Health Disparities. Am Surg 2024:31348241262431. [PMID: 38889953 DOI: 10.1177/00031348241262431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Background: The Trauma Recovery Clinic (TRC) was developed to meet the psychiatric, psychological, and psychosocial needs of traumatically injured patients following discharge from a level-I trauma center. The objective of this study is to demonstrate the efficacy of the TRC as an application of the stepped collaborative care model in order to address health disparities.Methods: Patients with a history of inpatient treatment for a physically traumatic injury at this level-I trauma center were approached and enrolled at initial TRC outpatient appointments. Data was collected, including the PTSD Checklist-Civilian Version (PCL-C), the Patient Health Questionnaire (PHQ-9), the Attitudes towards Guns scale, and the Youth Behavior Risk Survey (questions about weapon carrying practices).Results: A total of 80 patients were included in this study. Patients expressed several social determinants of health risk factors, with 60% of the sample reporting witnessing someone being wounded or killed. Results demonstrated a significant decrease in trauma symptoms (T24 = 3.33; P = .001, d = 0.67) and depressive symptoms (T24 = 2.23, P = .02, d = 0.45) by their 6th clinic visit. Additionally, patients reported significant improvements in role limitations due to emotional problems (T25 = 1.74; P = .04; d = 0.34) and social functioning (T25 = 2.23; P = .02; d = 0.43). Interestingly, patients who reported carrying a weapon in the last 30 days reported significantly higher trauma symptoms (T64 = 3.21, P = .002) and depressive symptoms (T64 = 2.77, P = .007).Discussion: This evaluation of services at the recently implemented Trauma Recovery Clinic demonstrated that the clinic is successfully treating individuals who have experienced traumatic injuries. More specifically, the clinic services are effectively engaging a vulnerable, hard-to-reach patient population.
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Affiliation(s)
- Erich J Conrad
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Erika M Rajo
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chikira Barker
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kaylin Beiter
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jennifer B Hughes
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sarah Stuart
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Lumbard DC, West MA, Cich IR, Hassan S, Shankar S, Nygaard RM. Pooled Analysis of Trauma Centers Better Predicts Risk Factors for Firearm Violence Reinjury. J Surg Res 2024; 297:1-8. [PMID: 38401378 DOI: 10.1016/j.jss.2024.01.046] [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: 01/26/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Many trauma centers use the first firearm injury admission as a reachable moment to mitigate reinjury. Understanding repeat firearm violence can be difficult in metropolitan areas with multiple trauma centers and laws that prohibit sharing private health information across health systems. We hypothesized that risk factors for repeat firearm violence could be better understood using pooled data from two major metropolitan trauma centers. METHODS Two level I trauma center registries were queried (2007-2017) for firearm injury admissions using International Classification of Diseases, Ninth and Tenth Revision (ICD9/10) Ecodes. A pseudo encryption tool allowed sharing of deidentified firearm injury and repeat firearm injury data without disclosing private health information. Factors associated with firearm reinjury admissions including, age, sex, race, payor, injury severity, intent, and discharge, were assessed by multivariable logistic regression. RESULTS We identified 2145 patients with firearm injury admissions, 89 of whom had a subsequent repeat firearm injury admission. Majority of repeat firearm admissions were assaulted (91%), male (97.8%), and non-Hispanic Black (86.5%). 31.5% of repeat firearm injury admissions were admitted to a different trauma center from their initial admission. Independent predictors of repeat firearm injuries were age (adjusted odds ratio [aOR] 0.94, P < 0.001), male sex (aOR 6.18, P = 0.013), non-Hispanic Black race (aOR 5.14, P = 0.007), or discharge against medical advice (aOR 6.64, P=<0.001). CONCLUSIONS Nearly a third of repeat firearm injury admissions would have been missed in the current study without pooled metropolitan trauma center data. The incidence of repeat firearm violence is increasing and those at the highest risk for reinjury need to be targeted for mitigating interventions.
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Affiliation(s)
- Derek C Lumbard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota.
| | - Michaela A West
- Department of Surgery, North Memorial Health Hospital, Minneapolis, Minnesota
| | - Irena R Cich
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Salma Hassan
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Sruthi Shankar
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, Minnesota
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Lehane A, Wood E, Pranikoff S, Avery M, Pranikoff T. Pediatric and Young Adult Trauma Recidivism. Am Surg 2024:31348241248698. [PMID: 38653577 DOI: 10.1177/00031348241248698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [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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Brandolino A, deRoon-Cassini TA, Biesboer EA, Tomas CW, Woolfolk M, Wakinekona NA, Subramanian M, Cheruvalath H, Schroeder ME, Trevino CM. Improved follow-up care for gun violence survivors in the Trauma Quality of Life Clinic. Trauma Surg Acute Care Open 2024; 9:e001199. [PMID: 38390473 PMCID: PMC10882323 DOI: 10.1136/tsaco-2023-001199] [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: 06/22/2023] [Accepted: 12/17/2023] [Indexed: 02/24/2024] Open
Abstract
Background Outpatient follow-up represents a crucial opportunity to re-engage with gun violence survivors (GVS) and to facilitate positive health outcomes. Current outpatient models for firearm-related injuries and trauma care are inconsistent and unstandardized across trauma centers. This project describes the patient population served by the multidisciplinary Trauma Quality of Life (TQoL) Clinic for GVS. Also of primary interest was the outpatient follow-up services used by patients prior to their clinic appointment. Subsequent referrals placed during Clinic, as well as rate of attendance, was a secondary aim. Methods This was a descriptive retrospective analysis of a quality improvement project of the TQoL Clinic. Data were extracted from the electronic medical record and were supplemented with information from the trauma registry and the hospital-based violence intervention program database. Descriptive statistics characterized the patient population served. A Χ2 analysis was used to compare no-show rates for the TQoL Clinic against two historical cohorts of trauma clinic attendees. Results Most attendees were young (M=32.0, SD=1.8, range=15-88 years), Black (80.1%), and male (82.0%). Of the 306 total TQoL Clinic attendees, 82.3% attended their initial scheduled appointment. Most non-attendee patients rescheduled their appointments (92.1%), and 89.5% attended the rescheduled appointment. TQoL Clinic demonstrated a significantly lower no-show rate than the traditional trauma clinic model, including after the implementation of the hospital's inpatient violence intervention program (χ2(2)=75.52, p<0.001). Conclusion The TQoL Clinic has demonstrated improved outpatient follow-up to address the comprehensive needs of GVS. Trauma centers with high gunshot wound volume should consider the implementation of the multidisciplinary TQoL Clinic model to increase access to care and to continue partnership with violence intervention programs to address health outcomes in those most at risk of future morbidity and mortality. Level of evidence Therapeutic/care management, level III.
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Affiliation(s)
- Amber Brandolino
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Terri A deRoon-Cassini
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
- Comprehensive Injury Center, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Elise A Biesboer
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carissa W Tomas
- Comprehensive Injury Center, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA
| | - Monet Woolfolk
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Nalani A Wakinekona
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maya Subramanian
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Heloise Cheruvalath
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Mary E Schroeder
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Colleen M Trevino
- Division of Trauma & Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Peterson C, Aslam MV, Rice KL, Gupta N, Kearns MC. Systematic Review of Per Person Violence Costs. Am J Prev Med 2024; 66:342-350. [PMID: 37572854 PMCID: PMC10807464 DOI: 10.1016/j.amepre.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION Data on the long-term and comprehensive cost of violence are essential for informed decision making regarding the future benefits of resources directed toward violence prevention. This review aimed to summarize original per-person estimates of the attributable cost of interpersonal violence to support public health economic research and decision making. METHODS In 2023, English-language peer-reviewed journal articles published in 2000-2022 with a focus on high-income countries reporting original per-person average cost of violence estimates were identified using index terms in multiple databases. Study contents, including violence type (e.g., adverse childhood experiences), timeline and payer cost perspective (e.g., hospitalization event-only healthcare payer cost), and associated per-person cost estimates, were summarized. Costs were in 2022 U.S. dollars. RESULTS Per-person cost estimates related to adverse childhood experiences, community violence, sexual violence, intimate partner violence, homicide, firearm violence, youth violence, workplace violence, and bullying from 73 studies (majority focusing on the U.S.) were summarized. For example, among 23 studies with a focus on adverse childhood experiences, monetary estimates ranged from $390 for adverse childhood experience-related annual healthcare out-of-pocket costs per U.S. adult with ≥3 adverse childhood experiences to $20.2 million for the lifetime societal economic burden of a U.S. child maltreatment fatality. CONCLUSIONS This review provides a descriptive summary of available per-person cost of violence estimates. Results can help public health professionals to describe the economic burden of violence, identify the best available estimate for a particular public health question, and address data gaps. Ultimately, understanding the long-term and comprehensive cost of violence is necessary to anticipate the economic benefits of prevention.
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Affiliation(s)
- Cora Peterson
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Maria V Aslam
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ketra L Rice
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nupur Gupta
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan C Kearns
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Miller T, Downing J, Wheeler L, Fischer K. The Medical Costs of Firearm Injuries in the United States: A Systematic Review. J Emerg Med 2024; 66:109-132. [PMID: 38262782 DOI: 10.1016/j.jemermed.2023.08.013] [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: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Firearm injury poses a significant public health burden in the United States. OBJECTIVES The purpose of this systematic review was to provide a comprehensive accounting of the medical costs of firearm injuries in the United States. METHODS A systematic literature review was conducted to identify studies published between January 1, 2000 and July 13, 2022 that reported medical costs of firearm injuries. A search of Embase, PubMed, and the Cochrane Library databases was performed by a medical librarian. The National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to evaluate for risk of bias. Health care-related charges and costs per firearm injury were presented and trends were identified. RESULTS Sixty-four studies were included in the analysis. Study sample sizes ranged from 18 to 868,483 patients. Reported costs per injury ranged from $261 to $529,609. The median cost reported was $27,820 (interquartile range [IQR] $15,133-$40,124) and median charge reported was $53,832 (IQR $38,890-$98,632). Studies that divided initial hospitalization costs and follow-up medical costs identified that initial hospitalization accounts for about 60% of total costs. CONCLUSIONS We found a significant volume of literature about the medical costs of firearm injury, which identified a highly heterogeneous cost burden. A significant amount of cost burden occurs after the index hospitalization, which is the only cost reported in most studies. Limitations of this study include reporting bias that favors hospitalized patients as well as a large focus on hospital charges as measurements of cost identified in the literature.
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Affiliation(s)
- Taylor Miller
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jessica Downing
- The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lauren Wheeler
- Health Sciences & Human Services Library, University of Maryland, Baltimore, Maryland
| | - Kyle Fischer
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Mueller KL, Cooper BP, Moran V, Lew D, Ancona R, Landman JM, Spruce M, Marotta P, Liss DB, Mancini MA, Schuerer D, Ranney ME, Foraker RE. Incidence of and Factors Associated With Recurrent Firearm Injury Among Patients Presenting to St. Louis Trauma Centers, 2010 to 2019 : A Cohort Study. Ann Intern Med 2023; 176:1163-1171. [PMID: 37639717 DOI: 10.7326/m23-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Firearm injuries are a public health crisis in the United States. OBJECTIVE To examine the incidence and factors associated with recurrent firearm injuries and death among patients presenting with an acute (index), nonfatal firearm injury. DESIGN Multicenter, observational, cohort study. SETTING Four adult and pediatric level I trauma hospitals in St. Louis, Missouri, 2010 to 2019. PARTICIPANTS Consecutive adult and pediatric patients (n = 9553) presenting to a participating hospital with a nonfatal acute firearm injury. MEASUREMENTS Data on firearm-injured patient demographics, hospital and diagnostic information, health insurance status, and death were collected from the St. Louis Region-Wide Hospital-Based Violence Intervention Program Data Repository. The Centers for Disease Control and Prevention (CDC) Social Vulnerability Index was used to characterize the social vulnerability of the census tracts of patients' residences. Analysis included descriptive statistics and time-to-event analyses estimating the probability of experiencing a recurrent firearm injury. RESULTS We identified 10 293 acutely firearm-injured patients of whom 9553 survived the injury and comprised the analytic sample. Over a median follow-up of 3.5 years (IQR, 1.5 to 6.4 years), 1155 patients experienced a recurrent firearm injury including 5 firearm suicides and 149 fatal firearm injuries. Persons experiencing recurrent firearm injury were young (25.3 ± 9.5 years), predominantly male (93%), Black (96%), and uninsured (50%), and resided in high social vulnerability regions (65%). The estimated risk for firearm reinjury was 7% at 1 year and 17% at 8 years. LIMITATIONS Limited data on comorbidities and patient-level social determinants of health. Inability to account for recurrent injuries presenting to nonstudy hospitals. CONCLUSION Recurrent injury and death are frequent among survivors of firearm injury, particularly among patients from socially vulnerable areas. Our findings highlight the need for interventions to prevent recurrence. PRIMARY FUNDING SOURCE Emergency Medicine Foundation-AFFIRM and Missouri Foundation for Health.
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Affiliation(s)
- Kristen L Mueller
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Benjamin P Cooper
- Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., R.E.F.)
| | - Vicki Moran
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri (V.M.)
| | - Daphne Lew
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri (D.L.)
| | - Rachel Ancona
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Joshua M Landman
- Institute for Informatics, Data Science, and Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri (J.M.L.)
| | - Marguerite Spruce
- Division of Acute & Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri; and Civilian Institutions Program, Air Force Institute of Technology, Wright-Patterson Air Force Base, Ohio (M.S.)
| | - Phillip Marotta
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri (P.M.)
| | - David B Liss
- Department of Emergency Medicine, Washington University in St. Louis School of Medicine, St. Louis, Missouri (K.L.M., R.A., D.B.L.)
| | - Michael A Mancini
- Saint Louis University School of Social Work, St. Louis, Missouri (M.A.M.)
| | - Douglas Schuerer
- Division of Acute & Critical Care Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri (D.S.)
| | - Megan E Ranney
- School of Public Health, Yale University, New Haven, Connecticut (M.E.R.)
| | - Randi E Foraker
- Institute for Public Health, Washington University in St. Louis School of Medicine, St. Louis, Missouri (B.P.C., R.E.F.)
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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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Neufeld MY, Plaitano E, Janeway MG, Munzert T, Scantling D, Allee L, Sanchez SE. History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence. J Trauma Acute Care Surg 2023; 95:143-150. [PMID: 37068014 PMCID: PMC10407825 DOI: 10.1097/ta.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence. METHODS All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate. RESULTS There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001). CONCLUSION Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Miriam Y Neufeld
- From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan
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Lumbard DC, Richardson CJ, Endorf FW, Nygaard RM. Firearm injury survival is only the beginning: The impact of socioeconomic factors on unplanned readmission after injury. Injury 2023:110893. [PMID: 37331896 DOI: 10.1016/j.injury.2023.110893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/02/2023] [Accepted: 06/11/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Firearm trauma remain a national crisis disproportionally impacting minority populations in the United States. Risk factors leading to unplanned readmission after firearm injury remain unclear. We hypothesized that socioeconomic factors have a major impact on unplanned readmission following assault-related firearm injury. METHODS The 2016-2019 Nationwide Readmission Database of the Healthcare Cost and Utilization Project was used to identify hospital admissions in those aged >14 years with assault-related firearm injury. Multivariable analysis assessed factors associated with unplanned 90-day readmission. RESULTS Over 4 years, 20,666 assault-related firearm injury admissions were identified that resulted in 2,033 injuries with subsequent 90-day unplanned readmission. Those with readmissions tended to be older (31.9 vs 30.3 years), had a drug or alcohol diagnosis at primary hospitalization (27.1% vs 24.1%), and had longer hospital stays at primary hospitalization (15.5 vs 8.1 days) [all P<0.05]. The mortality rate in the primary hospitalization was 4.5%. Primary readmission diagnoses included: complications (29.6%), infection (14.5%), mental health (4.4%), trauma (15.6%), and chronic disease (30.6%). Over half of the patients readmitted with a trauma diagnosis were coded as new trauma encounters. 10.3% of readmission diagnoses included an additional 'initial' firearm injury diagnosis. Independent predictors of 90-day unplanned readmission were public insurance (aOR 1.21, P = 0.008), lowest income quartile (aOR 1.23, P = 0.048), living in a larger urban region (aOR 1.49, P = 0.01), discharge requiring additional care (aOR 1.61, P < 0.001), and discharge against medical advice (aOR 2.39, P < 0.001). CONCLUSIONS Here we present socioeconomic risk factors for unplanned readmission after assault-related firearm injury. Better understanding of this population can lead to improved outcomes, decreased readmissions, and decreased financial burden on hospitals and patients. Hospital-based violence intervention programs may use this to target mitigating intervention programs in this population.
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Affiliation(s)
- Derek C Lumbard
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, United States.
| | - Chad J Richardson
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, United States
| | - Frederick W Endorf
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, United States
| | - Rachel M Nygaard
- Department of Surgery, Hennepin Healthcare, Minneapolis, MN 55415, United States
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Shayan M, Lew D, Mancini M, Foraker RE, Doering M, Mueller KL. A systematic review of recurrent firearm injury rates in the United States. Prev Med 2023; 168:107443. [PMID: 36740145 DOI: 10.1016/j.ypmed.2023.107443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/08/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To conduct a systematic review of methodologies, data sources, and best practices for identifying, calculating, and reporting recurrent firearm injury rates in the United States. METHODS In accordance with PRISMA guidelines, we searched seven electronic databases on December 16, 2021, for peer-reviewed articles that calculated recurrent firearm injury in generalizable populations. Two reviewers independently assessed the risk of bias, screened the studies, extracted data, and a third resolved conflicts. FINDINGS Of the 918 unique articles identified, 14 met our inclusion criteria and reported recurrent firearm injury rates from 1% to 9.5%. We observed heterogeneity in study methodologies, including data sources utilized, identification of subsequent injury, follow-up times, and the types of firearm injuries studied. Data sources ranged from single-site hospital medical records to comprehensive statewide records comprising medical, law enforcement, and social security death index data. Some studies applied machine learning to electronic health records to differentiate subsequent new firearm injuries from the index injury, while others classified all repeat firearm-related hospital admissions after variably defined cut-off times as a new injury. Some studies required a minimum follow-up observation period after the index injury while others did not. Four studies conducted survival analyses, albeit using different methodologies. CONCLUSIONS Variability in both the data sources and methods used to evaluate and report recurrent firearm injury limits individual study generalizability of individual and societal factors that influence recurrent firearm injury. Our systematic review highlights the need for development, dissemination, and implementation of standard practices for calculating and reporting recurrent firearm injury.
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Affiliation(s)
- Muhammad Shayan
- Cordell Institute for Policy in Medicine & Law, Washington University in St. Louis, United States.
| | - Daphne Lew
- Division of Biostatistics, Washington University in St. Louis, United States.
| | - Michael Mancini
- College for Public Health and Social Justice, Saint Louis University, United States.
| | - Randi E Foraker
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, United States.
| | - Michelle Doering
- Bernard Becker Medical Library, Washington University in St. Louis, United States
| | - Kristen L Mueller
- Department of Emergency Medicine, School of Medicine, Washington University in St. Louis, United States.
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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: 1] [Impact Index Per Article: 0.5] [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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13
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Cavalea AC, Tedesco A, Leonard J, Hunt JP, Schoen J, Smith AA, Greiffenstein P, Marr AB, Stuke LE. Mass shootings in the United States: Results from a five-year demographic analysis. Injury 2022; 53:925-931. [PMID: 35031108 DOI: 10.1016/j.injury.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 01/02/2022] [Indexed: 02/02/2023]
Affiliation(s)
| | | | - Jacob Leonard
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - John P Hunt
- Louisiana State University Health Sciences Center - New Orleans, LA USA; University Medical Center New Orleans - New Orleans, LA USA.
| | - Jonathan Schoen
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - Alison A Smith
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | | | - Alan B Marr
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
| | - Lance E Stuke
- Louisiana State University Health Sciences Center - New Orleans, LA USA.
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14
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Nehra D, Bulger EM, Maier RV, Moloney KE, Russo J, Wang J, Anderson K, Zatzick DF. A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms. Ann Surg 2021; 274:e364-e369. [PMID: 34225296 PMCID: PMC8434993 DOI: 10.1097/sla.0000000000005043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- The Koshka Foundation, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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15
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Unpacking the Causes of Post-Traumatic Stress Disorder in Violently Injured Patients. J Surg Res 2020; 256:43-47. [PMID: 32683055 DOI: 10.1016/j.jss.2020.06.015] [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: 02/29/2020] [Revised: 05/21/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Violence is a public health problem that disproportionately affects urban communities. The root causes of PTSD and effects on quality of life, substance abuse, and mental health are unclear. The purpose of this study was to evaluate the prevalence of PTSD and its root causes to direct services to be provided in a hospital-based violence intervention program. METHODS Victims of Violence (VOVs) at University Hospital were approached from December 2017 to June 2019. They completed several validated patient-reported outcome surveys, including the Traumatic Life Events Questionnaire, the Peritraumatic Dissociative Experiences Questionnaire, Peritraumatic Dissociative Inventory, Positive and Negative Affect Scale, and the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test. Responses were recorded in Research Electronic Data Capture and were analyzed using Microsoft Excel. RESULTS Fifty-four individuals completed the surveys; 94% were men, 88% black, and 100% victims of interpersonal violence. 85% screened positive for PTSD. VOVs experienced many traumatic events throughout their life. Reported alcohol and drug abuse were low, with 91% at low risk for alcohol use disorders and 92% at low risk for drug abuse disorders (Figure 1). Positive affect remained high, indicating the possibility of resiliency in this population. CONCLUSIONS PTSD is high in VOVs in urban trauma centers. Understanding the root causes of PTSD can help direct interventions to support individuals with services that meet their individual needs. Simple screening tools can help hospital-based violence intervention programs and trauma social workers identify individual needs and assess risk for mental health and substance abuse disorders.
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