Trauma recidivism is pervasive and is associated with mental and social health opportunities

Published:November 04, 2022DOI:


      • 14% of patients returned with an unrelated trauma event within a mean of 21 months following initial injury.
      • Mental illness was noted in 57% of recidivists, versus 33% of the others, representing the greater risk factor for trauma recidivism.
      • Other predictors of recidivism included recreational drug use and history of ballistic or other assault.



      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.


      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.


      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).


      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
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. WISQARS: Cost of injury reports. 2010 prices. National center for injury prevention and control, centers for disease control and prevention. Data source: National Center for Health statistics (NCHS_, national vital statistics system), accessed December 1, 2021.

      2. WISQARS, 10 leading causes of death, United states, 2019, All Races, Both sexes. National center for injury prevention and control, centers for disease control and prevention. Data source: National Center for Health statistics (NCHS_, national vital statistics system), accessed December 1, 2021.

        • Allan B.J.
        • Davis J.S.
        • Pandya R.K.
        • Jouria J.
        • Habib F.
        • Namias N.
        • Schulman C.I.
        Exploring trauma recidivism in an elderly cohort.
        J Surg Res. 2018; 184: 582-585
        • Caufeild J.
        • Singhal A.
        • Moulton R.
        • Brenneman F.
        • Redelmeier D.
        • Baker A.J.
        Trauma Recidivism in a Large Urban Canadian Population.
        J Trauma Inj Crit Care. 2004; 57: 872-876
        • Dixon S.D.
        • Como J.J.
        • Banerjee A.
        • Claridge J.A.
        Trauma recidivists: surprisingly better outcomes than initially-injured trauma patients.
        Am J Surg. 2014; 207: 427-431
        • Erdogan M.
        • Kureshi N.
        • Asbridge M.
        • Green R.S.
        Trauma recidivism in a Canadian province: a 14-year registry review.
        CJEM. 2019; 21: 473-476
        • Hedges B.E.
        • Dimsdale J.E.
        • Hoyt D.B.
        • Berry C.
        • Leitz K.
        Characteristics of repeat trauma patients.
        Am J Public Health. 1995; 85: 1-3
        • Kaufmann C.R.
        • Branas C.C.
        • Brawley M.L.
        A population-based study of trauma recidivism.
        J Trauma Acute Care Surg. 1998; 45: 325-332
        • Koleszar J.C.
        • Childs B.R.
        • Vallier H.A.
        Frequency of recidivism in patients with orthopedic trauma.
        Orthopedics. 2016; 39: 300-306
        • McCoy A.M.
        • Como J.J.
        • Greene G.
        • Laskey S.L.
        • Claridge J.A.
        A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history.
        J Trauma Acute Care Surg. 2013; 75: 116-121
        • Strong B.L.
        • Greene C.R.
        • Smith G.S.
        Trauma recidivism predicts long-term mortality: missed opportunities for prevention (retrospective cohort study).
        Ann Surg. 2017; 265: 847-853
        • Brooke B.S.
        • Efron D.T.
        • Chang D.C.
        • Haut E.R.
        • Cornwell E.E.
        Patterns and outcomes among penetrating trauma recidivists: it only gets worse.
        J Trauma Inj Crit Care. 2006; 61: 16-20
        • Cordovilla-Guardia S.C.
        • Garcia-Jimenez C.G.
        • Frenandiz-Mondejar
        • Calderon-Garica
        • Lopez-1Espuela F.
        • Franco-Antonio C.
        • Rico-Martin S.
        • Lardelli-Claret P
        Association between the detection of alcohol, illicit drugs and/or psychotropic medications/opioids in patients admitted due to trauma and trauma recidivism: A cohort analysis.
        PLoS One. 2018; 13e0203963
        • Cordovilla-Guardia S.
        • Vilar-Lopez R.
        • Lardelli-Claret P.
        • Guerrero-Lopez F.
        • Fernandez-Mondejar E.
        Alcohol or drug use and trauma recidivism.
        Nurs Res. 2017; 66: 399-404
        • Wan J.
        • Morabito D.J.
        • Khaw L.
        • Knudson M.M.
        • Dicker R.A.
        Mental illness as an independent risk factor for unintentional injury and injury recidivism.
        J Trauma Inj Crit Care. 2006; 61: 1299-1304
        • Alghnam S.
        • Tinkoff G.H.
        • Castillo R.
        Longitudinal assessment of injury recidivism among adults in the United States: findings form a population-based sample.
        Inj Epidemiol. 2016; 3: 5
        • Meinberg E.
        • Agel J.
        • Roberts C.
        • et al.
        Fracture and Dislocation Classification Compendium–2018.
        J Orthop Trauma. 2018; (32:Suppl): S1-S47
        • Kao A.M.
        • Schlosser K.A.
        • Arnold M.R.
        • Kasten K.R.
        • Colavita P.D.
        • Davis B.R.
        • Sing R.F.
        • Heniford B.T.
        Trauma recidivism and mortality following violent injuries in young adults.
        J Surg Res. 2019; 237: 140-147
        • Nygaard R.M.
        • Marek A.P.
        • Daly S.R.
        • Van Camp J.M.
        Violent trauma recidivism: Does all violence escalate?.
        Eur J Trauma Emerg Surg. 2018; 44: 851-858
        • Simske N.M.
        • Rivera T.
        • Ren B.O.
        • Vallier H.A.
        Victims of crime program decreases risk for new mental illness.
        J Ment Health Clin Psychol. 2022; 6: 3-10
        • Sinkler M.A.
        • Furdock R.J.
        • Vallier H.A.
        Treating trauma more effectively: A review of psychosocial programming.
        Injury. 2022; (Apr 26): S0020-S1383
        • Petrey L.B.
        • Weddle R.J.
        • Richardson B.
        • Gilder R.
        • Reynolds M.
        • Bennett M.
        • Cook A.
        • Foreman M.
        • Warren A.M.
        Trauma patient readmissions: Why do they come back for more?.
        J Trauma Acute Care Surg. 2015; 79: 717-724
        • Simske N.M.
        • Rivera T.
        • Breslin M.A.
        • Hendrickson S.B.
        • Simpson M.
        • Kalina M.
        • Ho V.P.
        • Vallier H.A.
        Implementing psychosocial programming at a Level 1 trauma center: results from a 5-year period. Trauma Surg Acute Care Open. 2020; 5e000363
        • Cordovilla-Guardia S.
        • Fernandez-Mondejar E.
        • Vilar-Lopez R.
        • Navas J.F.
        • Portillo-Santamaria M.
        • Rico-Martinez S
        Effect of a brief intervention for alcohol and illicit drug use on trauma recidivism in a cohort of trauma patients.
        PLoS One. 2017; 12e0182441
        • Belayneh R.
        • Haglin J.
        • Lott A.
        • et al.
        Underlying mental illness and psychosocial factors are predictors of poor outcomes after proximal humerus repair.
        J Orthop Trauma. 2019; 33: e339-e344
        • Surace P.A.
        • Boyd A.J.
        • Vallier H.A.
        Case series evaluating the operative and nonoperative treatment of scapular fractures.
        Am J Orthop. 2019;
        • Vranceanu A.M.
        • Bachoura A.
        • Weening A.
        • Vrahas M.
        • Smith R.M.
        • Ring D.
        Psychological factors predict disability and pain intensity after skeletal trauma.
        J Bone Joint Surg Am. 2014; 96: 20
        • Wegener S.T.
        • Castillo R.C.
        • Haythornthwaite J.
        • MacKenzie E.J.
        • Bosse LEAP Study Group
        Psychological distress mediates the effect of pain on function.
        Pain. 2011; 152: 1349-1357
        • Poole G.V.
        • Griswold J.A.
        • Thaggard V.K.
        • Rhodes R.S.
        Trauma is a recurrent disease.
        Surgery. 1993; 113: 608-611
        • Simske N.M.
        • Breslin M.A.
        • Hendrickson S.B.
        • Vallier H.A.
        Are we missing the mark: Relationships of psychosocial issues to outcomes. A review of the OTA annual meeting presentations.
        OTA International. 2020; 3: e70-e76
        • Smith R.S.
        • Fry W.R.
        • Morabito D.J.
        Recidivism in an Urban Trauma Center.
        Arch Surg. 1992; 127: 668-670
        • Laughon S.L.
        • Gaynes B.N.
        • Chrisco L.P.
        • Jones S.W.
        • Williams F.N.
        • Cairns B.A.
        • Gala G.J.
        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
        • Simske N.M.
        • Breslin M.A.
        • Hendrickson S.B.
        • Vallier H.A.
        Implementing recovery resources in trauma care: impact and implications.
        OTA International. 2019; 2: e045-e051
        • Nunn J.
        • Erdogan M.
        • Greed R.S.
        The prevalence of alcohol-related trauma recidivism: a systematic review.
        Injury. 2016; 47: 551-558
        • MacKenzie E.J.
        • Bosse M.J.
        Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP).
        J Am Acad Orthop Surg. 2006; 14 (10 Spec No.): S205-S210