Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis - 21/08/16
, Kristin Rising, MD, MS b, Douglas J. Wiebe, PhD c, David J. Ebler, MD d, Marie L. Crandall, MD, MPH e, M. Kit Delgado, MD, MS fAbstract |
Introduction |
Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.
Methods |
We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits.
Results |
Of 53 908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million.
Conclusions |
Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the nontrauma centers where many patients seek care.
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| ☆ | Sources of funding: No specific funding support was obtained for this research, but the first author was supported by a training grant from the National Heart, Lung and Blood Institute (T32 HL-98054-6). Dr. Delgado was supported by the National Heart, Lung, and Blood Institute Career Development Program in Emergency Care Research (K12HL109009). |
| ☆☆ | Presentation: Poster presentation, the 2016 Annual Scientific Assembly of the Eastern Association for the Surgery of Trauma; January 12-16, 2016; San Antonio, TX. |
| ★ | Conflicts of interest: The authors have no conflicts of interest to declare. |
| ★★ | Author contributions: E.J.K. had full access to the data and takes responsibility for the integrity and accuracy of the analysis. E.J.K. and K.L.R. are responsible for data acquisition. E.J.K. and M.K.D. are responsible for the concept and data analysis. E.J.K. drafted the manuscript. All authors contributed to critical review of the manuscript. |
Vol 34 - N° 9
P. 1823-1830 - septembre 2016 Retour au numéro
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