Abstract
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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References
- Web-based injury statistics query and reporting system.([accessed 12.10.14])
- The history of violence as a public health issue.AMA Vitual Mentor. 2009; 11: 167-172
- Urban trauma: a chronic recurrent disease.J Trauma Injury Infect Crit Care. 1988; 28: 940-946https://doi.org/10.1097/00005373-198807000-00092
- Long-term mortality of patients surviving firearm violence.Inj Prev. 2015; https://doi.org/10.1136/injuryprev-2015-041710
- Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration.Ann Intern Med. 2015; 162: 492-500https://doi.org/10.7326/m14-2362
- Violent and fatal youth trauma: is there a missed opportunity?.West J Emerg Med. 2012; 13: 146-150https://doi.org/10.5811/westjem.2011.6.6765
- Hospital-centered violence intervention programs: a cost-effectiveness analysis.Am J Surg. 2014; 209: 597-603https://doi.org/10.1016/j.amjsurg.2014.11.003
- Hospital-based violence intervention programs save lives and money.J Trauma Acute Care Surg. 2013; 75: 331-333https://doi.org/10.1097/TA.0b013e318294f518
- Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence.Ann Surg. 1999; 230: 473-483
- The urban epidemiology of recurrent injury: beyond age, race, and gender stereotypes.Acad Emerg Med. 1997; 4: 772-775
- Trauma recidivists: surprisingly better outcomes than initially injured trauma patients.Am J Surg. 2013; 207: 423-431https://doi.org/10.1016/j.amjsurg.2013.09.019
- The incidence of recurrent penetrating trauma in an urban trauma center.J Trauma Injury Infect Crit Care. 1991; 31: 1536-1538https://doi.org/10.1097/00005373-199111000-00013
- Repeat victims of violence in an urban trauma center.Violence Vict. 1995; 10: 183-194
- A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.J Trauma Acute Care Surg. 2013; 75: 116-121https://doi.org/10.1097/TA.0b013e31829231b7
- Recurrent intentional injury.J Natl Med Assoc. 1992; 84: 431-435
- Neighborhood socioeconomic status is associated with violent reinjury.J Surg Res. 2015; 199: 177-182https://doi.org/10.1016/j.jss.2015.03.086
- Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.West J Emerg Med. 2014; 15: 609-614https://doi.org/10.5811/westjem.2014.4.21275
- The effects of alcohol abuse on readmission for trauma.JAMA. 1993; 270: 1962-1964
- Saving lives and saving money: Hospital-based violence intervention is cost-effective.J Trauma Acute Care Surg. 2015; 78: 252-258https://doi.org/10.1097/TA.0000000000000527
- Geographic and temporal patterns of recurrent intentional injury in south-central Los Angeles.J Natl Med Assoc. 1996; 88: 970-972
- A longitudinal study of injury morbidity in an African-American population.JAMA. 1994; 271: 755-760
- The effect of previous traumatic injury on homicide risk.J Forensic Sci. 2014; 59: 986-990https://doi.org/10.1111/1556-4029.12416
- Preventing recurring injuries from violence: the risk of assault among Cleveland youth after hospitalization.Am J Public Health. 1996; 86: 1633-1636
- Patterns and outcomes among penetrating trauma recidivists: it only gets worse.J Trauma. 2006; 61https://doi.org/10.1097/01.ta.0000224143.15498.bb
- Characteristics of repeat trauma patients, San Diego County.Am J Public Health. 1995; 85: 1008-1010
- A population-based study of trauma recidivism.J Trauma. 1998; 45: 325-332
- Violent reinjury and mortality among youth seeking emergency department care for assault-related injury.JAMA Pediatr. 2015; 169: e96-104https://doi.org/10.1001/jamapediatrics.2014.1900
- A resource-based assessment of trauma care in the United States.J Trauma. 2004; 56: 173-178https://doi.org/10.1097/01.TA.0000056159.65396.7C
- Methodological issues when studying readmissions and revisits using hospital adminstrative data.in: HCUP Methods Series Report # 2011–01. 2011
- Healthcare Cost and Utilization Project (HCUP).(Available at:) ([Accessed January 1, 2015])
- Data Element Availability Map: HCUP Revisit Variables.(Available at:) ([Accessed August 15, 2015])
- Patient returns to the emergency department: the time-to-return curve.Acad Emerg Med. 2014; 21: 864-871https://doi.org/10.1111/acem.12442
- Clinical Classifications Software (CCS) for ICD-9-CM.(Available at:) ([Accessed May 14, 2015])
- Recommended framework for presenting injury mortality data.MMWR. 1997; 46: 1-33
- Strategies to improve external cause-of-injury coding in state-based hospital discharge and emergency department data systems.MMWR Recom Rep. 2008; 57 ([http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5701a1.htm Accessed February 25, 2016]): 1-15
- The facts hurt: a state-by-state injury prevention policy report.2013 ([Washington, DC])
- Addendum to Healthcare Cost and Utilization Project (HCUP) E-code evaluation report (updated for 2009).in: HCUP Methods Series Report #2004-06. Agency for Healthcare Research and Quality, U.S.2011 ([http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp Accessed February 25, 2016])
- Accuracy of external cause of injury codes reported in Washington State hospital discharge records.Inj Prev. 2001; 7: 334-338https://doi.org/10.1136/ip.7.4.334
- ICDPIC: Stata module to provide methods for translating International Classification of Diseases (Ninth Revision) diagnosis codes into standard injury categories and/or scores.(Available at:) ([Accessed July 20, 2015])
- Validation of ICDPIC software injury severity scores using a large regional trauma registry.Inj Prev. 2015; 21: 325-330https://doi.org/10.1136/injuryprev-2014-041524
- Missing data: Our view of the state of the art.Psychol Methods. 2002; 7: 147-177https://doi.org/10.1037//1082-989X.7.2.147
- Florida State Information.(Available at:) ([Accessed Noverber 8, 2015])
- Evaluation of techniques for handling missing cost-to-charge ratios in the USA Nationwide Inpatient Sample: a simulation study.J Comp Effect Res. 2015; 4: 473-483https://doi.org/10.2217/cer.15.28
- Evaluating performance of statewide regionalized systems of trauma care.J Trauma. 1990; 30: 681-688
- National Network of Hospital-Based Violence Intervention Programs.(Available at:) ([Accessed September 16, 2015])
- Violence is preventable: a best practices guide for launching & sustaining a hospital-based program to break the cycle of violence.Youth ALIVE!, Chicago, IL2011
- Before and after the trauma bay: the prevention of violent injury among youth.Ann Emerg Med. 2009; 53: 490-500https://doi.org/10.1016/j.annemergmed.2008.11.014
- Benefits of a hospital-based peer intervention program for violently injured youth.J Am Coll Surg. 2007; 205: 684-689https://doi.org/10.1016/j.jamcollsurg.2007.05.029
- A framework of trauma and trauma recidivism in adolescents and young adults.J Trauma Nurs. 1995; 2: 93-99
- Repeat victims of violence: report of a large concurrent case-control study.Arch Surg. 2000; 135: 837-843
- United States Census Bureau.([Accessed February 9, 2015])
- State-specific, racial and ethnic heterogeneity in trends of firearm-related fatality rates in the USA from 2000 to 2010.BMJ Open. 2014; 4: 1-9https://doi.org/10.1136/bmjopen-2014-005628
- 2010 Census of population and housing, population and housing unit counts, CPH-2-11, Florida, US.Government Printing Office, Washington, DC2012
- Violence in American cities: young black males in the answer, but what was the question?.Soc Sci Med. 1994; 39: 179-187https://doi.org/10.1016/0277-9536(94)90326-3
- Criminal correlates of injury-related emergency department recidivism.J Emerg Med. 2007; 32: 141-147https://doi.org/10.1016/j.jemermed.2006.05.041
- Resources for optimal care of the injured patient.American College of Surgeons, Chicago, IL2014
- Characteristics and outcomes of serious traumatic injury in older adults.J Am Geriatr Soc. 2002; 50: 215-222https://doi.org/10.1046/j.1532-5415.2002.50051.x
- Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: results of a randomized trial.Pediatrics. 2008; 122: 938-946https://doi.org/10.1542/peds.2007-2096
- A randomised controlled feasibility trial of alcohol consumption and the ability to appropriately use a firearm.Inj Prev. 2009; 15: 409-412https://doi.org/10.1136/ip.2008.020768
- Pathways to recurrent trauma among young black men: traumatic stress, substance use, and the “code of the street”.Am J Public Health. 2005; 95: 816-824https://doi.org/10.2105/AJPH.2004.044560
- 2010 Census special reports, the emergency and transitional shelter population: 2010, C2010SR-02.U.S. Government Printing Office, Washington, DC2012
- Dartmouth Atlas of Healthcare: Percent of Deaths Occurring in Hospital.(Available at:) ([Accessed August 25, 2015])
- Compressed Mortality File 1999-2013 on CDC WONDER Online Database. Compressed Mortality File 1999–2013 20;2S.(Available at:)http://wonder.cdc.gov/cmf-icd10.html([Accessed April 2, 2015])Date: 2014
- Self-reported violence-related outcomes for adolescents within eight weeks of emergency department treatment for assault injury.J Adolesc Health. 2011; 49: 440-442https://doi.org/10.1016/j.jadohealth.2011.01.009
- Cost-to-Charge Ratio Files. Healthcare Cost and Utilization Project (HCUP).(Available at:) ([Accessed February 25, 2015])
Article Info
Publication History
Published online: June 15, 2016
Accepted:
June 10,
2016
Received in revised form:
May 25,
2016
Received:
April 18,
2016
Footnotes
☆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.
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