Highlights
- •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.
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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Article info
Publication history
Published online: November 04, 2022
Accepted:
November 2,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
