A. M. Kao1, K. A. Schlosser1, M. R. Arnold1, P. D. Colavita1, R. F. Sing2, T. Prasad1, A. E. Lincourt1, B. R. Davis1, B. T. Heniford1 1Carolinas Medical Center,Gastrointestinal And Minimally Invasive Surgery,Charlotte, NC, USA 2Carolinas Medical Center,Trauma/Critical Care,Charlotte, NC, USA
Introduction: Trauma recidivism accounts for a significant number of emergency department and trauma center admissions. Injuries associated with recurrent violent trauma result in increased treatment costs and are a significant public health burden due to higher rates of morbidity and mortality in this patient cohort.
Methods: A prospectively maintained registry of patients presenting to a Level 1 Trauma Center was queried for patients ages 18 to 25 years who sustained a gunshot wound (GSW), stab wound, or blunt assault between 2009-2015. Demographics, injury data, and discharge disposition were reviewed. Patients presenting with violent injuries were compared using Chi square, Fisher’s exact tests and Kruskal-Wallis test. Primary outcomes included mortality and trauma recidivism, identified by patients who presented with at least two unrelated violent traumas during the study period. Re-hospitalization for complications resulting from the initial injury was excluded. Out-of-hospital mortality was identified using the Social Security Death Database.
Results:A total of 6,484 patients between 18-25 years presented to the Level 1 Trauma Center; 1,215 (18.7%) had sustained a blunt assault, GSW, or stab wound. Patients with violent injuries were 87.4% male, with mean age of 22.1±2.2 years; the distribution of injuries included 64.4% GSW, 21.1% stab, and 14.8% blunt assault. Compared to patients in the same age cohort who sustained non-violent injuries, patients with violent injuries had a greater risk of mortality (8.0% vs. 2.1%, p<0.0001). Out-of-hospital mortality was 1.3% (vs 0.46% in non-violent, p<0.0005), with average time to death of 5.2±14.6 months from initial injury. The delayed mortality was significantly more likely in patients who initially presented after a GSW (89.7% vs 5.2% stab wound or 5.2% blunt assault, p<0.0001). Recidivism was 23.5% with mean time to second violent injury at 31.9±21.0 months; 15.0% had two unrelated trauma readmissions and 6.0% had 3 or more unrelated admissions. 90% of subsequent injuries occurred within 5 years, with 19% in the first 12 months. Initial injury in recidivists was GSW in 63.3%, compared to 22.3% with initial injury of stab wound and blunt assault 22.3% (p<0.001). 59.6% of patients who returned with an unrelated, second violent injury sustained a blunt assault, followed by GSW (26.6%) and stab wound (13.7%). There was no difference in age, length of stay, initial ED vitals, or injury severity score that correlated with trauma recidivism.
Conclusion:
In young trauma patients sustaining a violent injury, the burden of injury extends past discharge as patients have a significantly higher rate of mortality after discharge. Nearly one-quarter of patients will represent due to violent trauma. Improved medical, psychological, and social collaborative treatment of these high-risk patients is needed to interrupt the cycle of violent injury.