Erdogan Mete, Kureshi Nelofar, Asbridge Mark, Green Robert S
Trauma Nova Scotia, Department of Health and Wellness, Halifax, NS.
Division of Neurosurgery, Department of Surgery, Dalhousie University, Halifax, NS.
CJEM. 2019 Jul;21(4):473-476. doi: 10.1017/cem.2018.496. Epub 2019 Jan 30.
To determine the rate of recurrent major trauma (i.e., trauma recidivism) using a provincial population-based trauma registry. We compared outcomes between recidivists and non-recidivists, and assessed factors associated with recidivism and mortality.
Review of all adult (>17 years) major trauma patients in Nova Scotia (2001-2015) using data from the Nova Scotia Trauma Registry. Outcomes of interest were mortality, duration of hospital stay, and in-hospital complications. Multiple regression was used to assess factors associated with recidivism and mortality.
Of 9,365 major trauma patients, 2% (150/9365) were recidivists. Mean age at initial injury was 52 ± 21.5 years; 73% were male. The mortality rate for both recidivists and non-recidivists was 31%. However, after adjusting for potential confounders the likelihood of mortality was over 3 times greater for recidivists compared to non-recidivists (OR 3.67, 95% CI 2.06-6.54). Other factors associated with mortality included age, male gender, penetrating injury, Injury Severity Score, trauma team activation (TTA) and admission to the intensive care unit. The only variables associated with recidivism were age (OR 0.98, 95% CI 0.97-1.00) and TTA (OR 0.59, 95% CI 0.34-0.96).
This is the first provincial investigation of major trauma recidivism in Canada. While recidivism was infrequent (2%), the adjusted odds of mortality were over three times greater for recidivists. Further research is warranted to determine the effectiveness of strategies for reducing rates of major trauma recidivism such as screening and brief intervention in cases of violence or substance abuse.
使用省级人群创伤登记处的数据确定复发性重大创伤（即创伤再犯）的发生率。我们比较了再犯者和非再犯者的结局，并评估了与再犯和死亡率相关的因素。
使用新斯科舍省创伤登记处的数据，回顾新斯科舍省（2001 - 2015年）所有成年（>17岁）重大创伤患者。感兴趣的结局包括死亡率、住院时间和住院并发症。采用多元回归分析评估与再犯和死亡率相关的因素。
在9365例重大创伤患者中，2%（150/9365）为再犯者。初次受伤时的平均年龄为52±21.5岁；73%为男性。再犯者和非再犯者的死亡率均为31%。然而，在对潜在混杂因素进行调整后，再犯者的死亡可能性比非再犯者高出3倍多（比值比3.67，95%置信区间2.06 - 6.54）。与死亡率相关的其他因素包括年龄、男性性别、穿透性损伤、损伤严重程度评分、创伤团队激活（TTA）和入住重症监护病房。与再犯相关的唯一变量是年龄（比值比0.98，95%置信区间0.97 - 1.00）和TTA（比值比0.59，95%置信区间0.34 - 0.96）。
这是加拿大首次对省级重大创伤再犯情况进行的调查。虽然再犯情况不常见（2%），但调整后的再犯者死亡几率高出三倍多。有必要进行进一步研究，以确定降低重大创伤再犯率策略的有效性，如对暴力或药物滥用情况进行筛查和简短干预。
