Koleszar Juliann C, Childs Benjamin R, Vallier Heather A
Orthopedics. 2016 Sep 1;39(5):300-6. doi: 10.3928/01477447-20160623-05. Epub 2016 Jul 1.
The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].
本研究的目的是确定创伤再发的频率并识别风险因素。作者假设药物滥用和精神疾病与再发有关。他们对879例在4年期间接受高能骨折手术治疗的患者进行了回顾性研究。再发被定义为因新的、无关的损伤到创伤中心就诊。复发性再发患者是指因不止一次额外损伤而再次就诊的患者。该研究确定了164例（18.7%）因新损伤而再次就诊的患者。再发患者的平均年龄为37.1岁，而非再发患者为40.7岁（P = 0.025）。在再发患者中，80%为男性，该组更可能未婚（76.2%对67.2%，P = 0.044）和失业（40.4%对19.6%，P < 0.0001）。再发患者也更可能未参保（33.5%对17.8%，P < 0.0001）或有医疗补助覆盖（33.5%对23.2%，P < 0.0001）。再发患者在基线时更可能饮酒（47.2%对32.0%，P = 0.0007）或处于醉酒状态（32.4%对21.2%，P = 0.005），以及使用烟草（66.2%对50.2%，P = 0.0003）或消遣性药物（59.1%对43.2%，P = 0.0004）。有记录的精神疾病发生率在复发性患者中也高于非复发性患者（28.1%对20.0%，P = 0.03）。这些发现表明再发很常见，在研究样本中总体发生率为18.7%，平均发生时间为2.9年。与再发相关的因素包括年龄小于40岁、未婚状态、药物使用、失业和缺乏保险覆盖。再发的最大独立风险因素是医疗补助保险或无保险以及有枪伤或袭击史。[《骨科》。2016；39(5):300 - 306。]
