Violent trauma recidivism: Does all violence escalate?
Rates of trauma patients presenting with history of prior trauma range from 25 to 44%. Outcomes involving recidivists in the setting of intentional trauma, especially penetrating trauma, are conflicting. We hypothesized that if violence does escalate with successive incidence, then injuries due to successive violence should escalate or become increasingly severe with successive admissions.
The trauma registry from an urban level I adult and pediatric trauma center was queried for injuries due to blunt assault, stabbing, and firearm injury. Primary outcome measures were mortality, injury mechanism, and injury severity for each successive trauma admission.
Victims of blunt assault and stabbing were more likely to become recidivists than victims of gun violence (OR 1.53, p < 0.001 and OR 1.57, p < 0.001). Violent re-injury became increasingly severe only in victims of repeated gun violence. Patients with gunshot as the mechanism at every admission are at highest risk for mortality (OR 13.48, p < 0.001). All but one mortality (95.8%) in the recidivist population occurred within 180 days of discharge from a prior injury.
Recidivism for interpersonal violence results in a significant number of admissions to trauma centers. In our patient cohort, injury associated with successive blunt assaults did not worsen with subsequent admissions. Recidivism for gunshot wounds tends to be more severe and have a worse prognosis with each successive admission compared to outcomes associated with repeated stab wounds. Focused efforts should include rehabilitation efforts early in the post-injury period, especially in patients with a history of gunshot wounds.
KeywordsViolent injury Trauma Intentional trauma Recidivism Repeat trauma
The authors would like to thank Bridget Morrison for her help abstracting data from the trauma registry.
RMN, APM, SRD, and JMVC contributed to conception and design, SRD and RMN collected the data. SRD, RMN, APM, and JMVC analyzed and interpreted the data. RMN wrote the article. APM, SRD, and JMVC critically revised the article.
Compliance with ethical standards
Conflict of interest
Rachel Nygaard, Ashley Marek, Sam Daly, and Joan Van Camp declare that they have no conflict of interest.
Research involving Human Participants and/or animals
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
This study was deemed exempt from written consent documentation.
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