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.
- 1.CDC. 10 leading causes of death by age group, United States—2013 [Internet]. Natl. Cent. Inj. Prev. Control. p. CDC using WISQARS. Available from: http://www.cdc.gov/injury/images/lc-charts/leading_causes_of_death_by_age_group_2013-a.gif.
- 2.Sims D, Bivins B, Obeid F, Horst H, Sorensen V, Fath J. Urban trauma: a chronic recurrent disease. J. Trauma [Internet]. 1989;29:940–7. Available from: http://journals.lww.com/jtrauma/Abstract/1989/07000/Urban_Trauma__A_Chronic_Recurrent_Disease.6.aspx [cited 2015 Apr 8].CrossRefGoogle Scholar
- 3.Morrissey T, Byrd C, Deitch E. The incidence of recurrent penetrating trauma in an urban trauma center. J. Trauma [Internet]. 1991;31:1536–8. Available from: http://journals.lww.com/jtrauma/Abstract/1991/11000/The_Incidence_of_Recurrent_Penetrating_Trauma_in.13.aspx [cited 2015 Apr 8].CrossRefGoogle Scholar
- 5.McCoy AM, Como JJ, Greene G, Laskey SL, Claridge J a. A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history. J. Trauma Acute Care Surg. [Internet]. 2013;75:116–21. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23778450 [cited 2015 Jan 14].CrossRefGoogle Scholar
- 7.Caufeild J, Singhal a, Moulton R, Brenneman F, Redelmeier D, Baker AJ. Trauma recidivism in a large urban Canadian population. J Trauma Inj Infect Crit Care [Internet]. 2004;57:872–6. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00005373-200410000-00026 [cited 2015 Jan 14].CrossRefGoogle Scholar
- 10.Dixon SD, Como JJ, Banerjee A, Claridge JA. Trauma recidivists: surprisingly better outcomes than initially injured trauma patients. Am. J. Surg. [Internet]. Elsevier Inc; 2014;207:427–31 (discussion 431). Available from: http://www.ncbi.nlm.nih.gov/pubmed/24439159 [cited 2015 Jan 29].CrossRefGoogle Scholar
- 13.Cunningham RM, Carter PM, Ranney M, Zimmerman M a., Blow FC, Booth BM, et al. Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr. [Internet]. 2015 [cited 2015 Apr 8];169:63–70. Available from: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/jamapediatrics.2014.1900.CrossRefGoogle Scholar
- 14.Chong VE, Lee WS, Victorino GP. Neighborhood socioeconomic status is associated with violent reinjury. J. Surg. Res. [Internet]. Elsevier Inc; 2015;1–6. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0022480415003510.
- 16.Alghnam S, Tinkoff GH, Castillo R. Longitudinal assessment of injury recidivism among adults in the United States: findings from a population-based sample. Inj Epidemiol [Internet]. 2016;3:epub. Available from: http://www.injepijournal.com/content/3/1/5.
- 17.Madden C, Garrett JM, Cole TB, Runge JW, Porter CQ. The urban epidemiology of recurrent injury: beyond age, race, and gender stereotypes. Acad. Emerg Med yr [Internet]. 1997;4:772–5. Available from: http://doi.wiley.com/10.1111/j.1553-2712.1997.tb03782.x.CrossRefGoogle Scholar
- 20.Caputo ND, Shields CP, Ochoa C, Matarlo J, Leber M, Madlinger R, et al. Violent and fatal youth trauma: is there a missed opportunity? West J Emerg Med [Internet]. 2012;13:146–50. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3415801&tool=pmcentrez&rendertype=abstract [cited 2015 Jan 29].