From the Department of Surgery (W.A.M., M.E.E., M.C.B., G.A.F., N.A.N., J.W.S., J.D.R., B.G.H., M.V.B., K.R.M.), University of Louisville School of Medicine; and Trauma Institute (A.P.), University of Louisville Hospital, Louisville, Kentucky.
J Trauma Acute Care Surg. 2020 Aug;89(2):371-376. doi: 10.1097/TA.0000000000002746.
Recidivism is a key outcome measure for injury prevention programs. Firearm injury recidivism rates are difficult to determine because of poor longitudinal follow-up and incomplete, disparate databases. Reported recidivism rates from trauma registries are 2% to 3%. We created a collaborative database merging law enforcement, emergency department, and inpatient trauma registry data to more accurately determine rates of recidivism in patients presenting to our trauma center following firearm injury.
A collaborative database for Jefferson County, Kentucky, was constructed to include violent firearm injuries encountered by the trauma center or law enforcement from 2008 to 2019. Iterative deterministic data linkage was used to create the database and eliminate redundancies. From patients with at least one hospital encounter, raw recidivism rates were calculated by dividing the number of patients injured at least twice by the total number of patients. Cox proportional hazard models were used to evaluate risk factors for recidivism. The cumulative incidence of recidivism over time was estimated using a Kaplan-Meier survival model.
There were 2, 363 assault-type firearm injuries with at least 1 hospital encounter, approximately 9% of which did not survive their initial encounter. The collaborative database demonstrated raw recidivism rates for assault-type firearm injuries of 9.5% compared with 2.5% from the trauma registry alone. Risk factors were young age, male sex, and African American race. The predicted incidence of recidivism was 3.6%, 5.6%, 11.4%, and 15.8% at 1, 2, 5, and 10 years, respectively.
Both hospital and law enforcement data are critical for determining reinjury rates in patients treated at trauma centers. Recidivism rates following violent firearm injury are four times higher using a collaborative database compared with the inpatient trauma registry alone. Predicted incidence of recidivism at 10 years was at least 16% for all patients, with high-risk subgroups experiencing rates as high as 26%.
Epidemiological, level III.
再犯是伤害预防计划的一个关键结果衡量标准。由于纵向随访不良和数据库不完整、不相关，枪支伤害再犯率难以确定。创伤登记处报告的再犯率为 2%至 3%。我们创建了一个协作数据库，合并执法部门、急诊部和住院创伤登记处的数据，以更准确地确定我们创伤中心收治的枪支伤害患者的再犯率。
肯塔基州杰斐逊县的一个协作数据库，包括 2008 年至 2019 年期间由创伤中心或执法部门遇到的暴力枪支伤害。迭代确定性数据链接用于创建数据库并消除冗余。从至少有一次住院经历的患者中，通过将至少两次受伤的患者人数除以总患者人数来计算原始再犯率。使用 Cox 比例风险模型评估再犯的危险因素。使用 Kaplan-Meier 生存模型估计随时间推移的再犯累积发生率。
有 2363 例侵袭性枪支伤害至少有 1 次住院经历，其中约 9%的患者在初次就诊时未存活。协作数据库显示，侵袭性枪支伤害的原始再犯率为 9.5%，而创伤登记处单独报告的再犯率为 2.5%。危险因素为年龄较小、男性和非裔美国人种族。再犯的预测发生率分别为 1、2、5 和 10 年时的 3.6%、5.6%、11.4%和 15.8%。
医院和执法部门的数据对于确定在创伤中心接受治疗的患者的再受伤率都很重要。使用协作数据库与单独使用住院创伤登记处相比，暴力枪支伤害后的再犯率高出四倍。所有患者的 10 年再犯预测发生率至少为 16%，高危亚组的发生率高达 26%。
流行病学，三级。
