Approximately 3.4 percent of patients treated in rural trauma centers are repeat visitors, according to a report by East Carolina University surgeons in the January issue of Archives of Surgery.
The study says recidivists, as the repeat patients are called, have visited the trauma center more than once for separate injuries, and substance abuse appears to be the common feature among urban and rural recurrent trauma patients.
“It was a translation of a daily problem into a research question,” said Dr. Eric Toschlog, associate professor of trauma at the Brody School of Medicine and lead author of the study.
Toschlog and other trauma surgeons at the Brody School of Medicine assessed 15,370 consecutive patients admitted to the level 1 trauma center at Pitt County Memorial Hospital between 1994 and 2002. A national trauma registry was used to identify patients who were admitted for distinct injuries two, three, four and five times during the study period. Demographic and clinical information, including blood alcohol levels and toxicology results, were obtained from the database.
A total of 528 patients, or 3.4 percent, were admitted to the trauma center a second time for a different injury. The total cost for these admissions was more than $7 million. Compared with patients admitted only once, patients with recurrent admissions for trauma had the following characteristics:
- Were older (55.9 years vs. 39.7 years)
- Were disproportionately white (65.2 percent vs. 56.5 percent)
- Were more often female (49.1 percent vs. 37.3 percent)
- Had a higher percentage of positive blood alcohol screening results (58.7 percent vs. 39.9 percent)
- Had higher average blood ethanol levels (132.1 milligrams per deciliter vs. 69.5 milligrams per deciliter)
- Had higher rates of cocaine use (6.4 percent vs. 4.1 percent)
- Were more likely to be injured in a fall (63.8 percent of those admitted three to five times and 47.2 percent of those admitted twice vs 24.4 percent of those admitted only once)
- Were less likely to be injured in a vehicle crash (10.3 percent of those admitted three to five times and 28.4 of those admitted twice vs. 48.1 percent of non-recidivists)
According to Toschlog, recidivists tended to fall into two categories: young males, often Hispanic, who drank or used drugs and were injured through violence; and elderly women who fell, some while impaired by alcohol or drugs.
The rate of recurrent injury was lower than in urban trauma centers, and many of these characteristics differ from those found in studies of trauma recidivists in urban populations, who tend to be young, male and injured by violent means, according to the study.
Trauma is the leading cause of death and disability for people 40 and younger, according to background information in the article. Historically, trauma centers have focused on reducing death and disability following injury; however, it is now recognized that, like other diseases, trauma affects certain individuals in high-risk groups.