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Trauma Recidivism Predicts Long-term Mortality: Missed Opportunities for Prevention (Retrospective Cohort Study)

Strong, Bethany L. MD, MS; Greene, Christina R. MS; Smith, Gordon S. MB, ChB, MPH

doi: 10.1097/SLA.0000000000001823

Objectives: The objectives of this study were to determine the association between recurrent trauma admissions (recidivism) and subsequent long-term mortality, and to identify those in most need for preventive interventions.

Background: Patients with a single intentional injury have been shown to have a higher risk of future injury mortality than those with unintentional injury with 5-year mortality rates as high as 20% being reported for recurrent penetrating trauma. Trauma recidivism identifies a high-risk population, but its association with long-term mortality is largely unknown.

Methods: Patients with 1 or more previous admissions to an urban trauma center (recidivists) were identified and compared with those with single admissions (nonrecidivists) from 1997 to 2008. The trauma registry was linked to the National Death Index to determine both the cause and time to death after hospital discharge. Statistical analysis included chi-square tests, Kaplan-Meier survival curves, and Cox proportional-hazards models.

Results: Trauma recidivists were 7% of the total trauma population from 1997 to 2008, representing 3147 patients. Recidivists were more likely to be male (P < 0.0001), Black (P < 0.0001), have a blood alcohol content above 80 mg/dL (P < 0.0001), and suffer a penetrating injury (P < 0.0001) compared with nonrecidivists. Recidivists with both initial blunt and penetrating injuries had higher rates of long-term mortality after discharge. Recidivists were more likely to die of any cause based on Cox proportional-hazard ratios [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.57–2.01], injury death (HR 2.02, 95% CI 1.66–2.47), and disease death (HR 1.65, 95% CI 1.41–1.92) than nonrecidivists.

Conclusions: Male sex, Black race, and elevated blood alcohol content and penetrating injury are associated with trauma recidivism which leads to a higher risk of death. There is a critical public health need to develop interventions to reduce trauma recidivism and preventable death.

University of Maryland School of Medicine, Department of Epidemiology and Public Health and National Study Center for Trauma and EMS, Baltimore, MD.

Reprints: Bethany L. Strong, MD, MS, 75 Francis Street, Boston, MA, 02115. E-mail:

B.L.S. is a Board Certified Preventive Medicine Physician and General Surgery Resident; C.R.G. is a PhD candidate in epidemiology; G.S.S. is the Stuart M. and Joyce N. Robbins Distinguished Professor.

The authors, faculty and all staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

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