West J Emerg Med. 2012 May;13(2):146-50. doi: 10.5811/westjem.2011.6.6765.
Accidents and assaults (homicides) are the leading causes of death among the youth of the United States, accounting for 53.3% of deaths among children aged 1 to19 years. Victim recidivism, defined as repeated visits to the emergency department (ED) as a victim of violent trauma, is a significantly growing public health problem. As 5-year mortality rates for recidivism are as high as 20%, it is important to determine whether victims with a history of violent trauma are at increased risk for fatal outcome with their next trauma. We hypothesized that victims of violent trauma who have had 1 prior ED visit for violent trauma will have increased odds of fatal outcome.
A retrospective chart review was conducted for patients presenting with penetrating trauma to the ED from January 1, 1999 to December 31, 2009. All patients between the ages of 15 to 25 years who presented to the ED for any penetrating trauma were included. Patients with prior presentations for penetrating trauma were compared to those patients who were first-time presenters to determine the odds ratio of fatal outcome.
Overall, 15,395 patients were treated for traumatic presentations. Of these, 1,044 met inclusion criteria. Demographically, 79.4% were Hispanic, 19.4% were African American, and 0.96% were Caucasian. The average age was 21 years, and 98% of the population was male. One hundred and forty-seven (14%) had prior presentations, and 897 (86%) did not. Forty of the 147 patients (27%) with prior presentations had a fatal outcome as compared to 29 patients of the 868 (3%) without prior presentations, with odds ratio of 10.8 (95% confidence interval, 6.4-18.1; Pearson χ(2), P < 0.001). The 5-year mortality rate for those patients with fatal outcomes was calculated at 16.5%.
Patients who had prior ED visits for penetrating trauma were at greater risk for fatal outcomes compared to those with no prior visits. Therefore, trauma-related ED visits might offer an opportunity for education and intervention. This may help to prevent future fatalities.
在美国，意外伤害和袭击（凶杀）是导致青少年死亡的主要原因，占 1 至 19 岁儿童死亡人数的 53.3%。受害者再次受害，即因暴力创伤多次到急诊部（ED）就诊，是一个显著增长的公共卫生问题。由于再次受害的 5 年死亡率高达 20%，因此确定是否有暴力创伤史的受害者在下一次创伤时发生致命后果的风险增加是很重要的。我们假设，曾因暴力创伤到急诊部就诊 1 次的暴力创伤受害者，其致命后果的可能性增加。
对 1999 年 1 月 1 日至 2009 年 12 月 31 日期间因穿透性创伤到急诊部就诊的患者进行了回顾性图表审查。所有年龄在 15 至 25 岁之间因任何穿透性创伤到急诊部就诊的患者均被纳入研究。将有过穿透性创伤就诊史的患者与初次就诊的患者进行比较，以确定致命后果的比值比。
共有 15395 例患者因创伤就诊。其中，1044 例符合纳入标准。从人口统计学上看，79.4%为西班牙裔，19.4%为非裔美国人，0.96%为白种人。平均年龄为 21 岁，98%的人群为男性。有 147 人（14%）有就诊史，897 人（86%）没有就诊史。在 147 例有就诊史的患者中，有 40 例（27%）发生了致命后果，而在 868 例无就诊史的患者中，有 29 例（3%）发生了致命后果，比值比为 10.8（95%置信区间，6.4-18.1；皮尔逊卡方检验，P<0.001）。有致命后果的患者的 5 年死亡率为 16.5%。
与无就诊史的患者相比，因穿透性创伤到急诊部就诊的患者发生致命后果的风险更高。因此，与创伤相关的急诊部就诊可能为教育和干预提供机会。这可能有助于预防未来的死亡事件。
