Division of Trauma, Critical Care, and Burns, Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.
J Trauma Acute Care Surg. 2013 Jul;75(1):116-21. doi: 10.1097/TA.0b013e31829231b7.
The purpose of this study was to determine the incidence and burden of trauma recidivism at a regional Level 1 trauma center by incorporating the concept of the past trauma history (PTHx) into the general trauma history.
All trauma patients who met prehospital trauma criteria and activated the trauma team during a 13-month period were asked about their PTHx, that is, their history of injury in the previous 5 years. A recidivist presented more than once for separate severe injuries. Recurrent recidivists presented multiple times during the study period.
Of the 4,971 trauma activations during the study period, 1,246 (25.2%) were identified as recidivists. Recidivists were 75% male, 62% white, 36% unemployed, 26% uninsured, and 90% unmarried. The recidivism rate among admitted patients was 23.4% compared with 29.3% in those discharged from the emergency department. The highest recidivism rates were noted in patients who reported alcohol or illegal drug use on the day of injury and in victims of interpersonal violence (IPV), defined as those who sustained gunshot wounds, stab wounds, or assaults, Those involved in IPV were more likely to have been involved in IPV at the previous trauma than those with other trauma mechanisms. Key risk factors for recidivism among all patients were male sex and single marital status. Seventy-three patients (1.5%) were recurrent recidivists, representing 157 unique encounters.
This is the highest trauma recidivism rate reported on a large population of all consecutive trauma activations at a regional Level 1 trauma center. These data illustrate the tremendous burden of recidivism in the modern era, more than previously recognized. Efforts specifically targeting those involved in IPV may reduce recidivism rates. Incorporating the concept of the PTHx into the general history of the trauma patient is feasible and provides valuable information to the provider.
Prognostic study, level II.
本研究旨在通过将既往创伤史（PTHx）概念纳入一般创伤史，确定区域性 1 级创伤中心的创伤再入院发生率和负担。
在 13 个月的时间内，对符合院前创伤标准并激活创伤小组的所有创伤患者询问其 PTHx，即过去 5 年内的受伤史。再入院患者因单独的严重损伤而不止一次就诊。复发性再入院患者在研究期间多次就诊。
在研究期间，4971 次创伤激活中有 1246 次（25.2%）被确定为再入院患者。再入院患者中 75%为男性，62%为白人，36%失业，26%没有保险，90%未婚。住院患者的再入院率为 23.4%，而急诊科出院患者的再入院率为 29.3%。报告受伤当天饮酒或使用非法药物以及人际暴力（IPV）受害者的再入院率最高，定义为那些遭受枪伤、刺伤或袭击的受害者。那些参与 IPV 的人比那些有其他创伤机制的人更有可能在前一次创伤中参与 IPV。所有患者再入院的主要危险因素是男性和单身婚姻状况。73 名患者（1.5%）为复发性再入院患者，代表 157 次独特就诊。
这是在区域性 1 级创伤中心对大量连续创伤激活人群报告的最高创伤再入院率。这些数据说明了在现代社会中，再入院率巨大，超过了之前的认识。有针对性地针对那些参与 IPV 的人可能会降低再入院率。将 PTHx 概念纳入创伤患者的一般病史是可行的，并为提供者提供了有价值的信息。
预后研究，二级。
