title: Patterns and outcomes among penetrating trauma recidivists: it only gets worse.
abstract: BACKGROUND
  Trauma recidivism accounts for a significant proportion of visits to urban trauma centers. The current study was designed to characterize injury patterns among individual recidivists and analyze their impact on mortality.
  
  
  METHODS
  Recidivists were identified within a trauma registry from an urban level-one trauma center from a period between 1997 and 2004. Demographic, injury type, and final disposition data were retrospectively reviewed. The primary outcomes measured were all-cause mortality and injury mechanism. The data were analyzed using the chi2 method, and logistic regression analysis.
  
  
  RESULTS
  Among 15,973 total trauma visits, 2,511 (15.7%) were by recidivists, representing 1,528 unique patients. Of these recidivists, 794 (52%) had their first trauma admission during the period reviewed (84% male, 87% African-American, mean age 31 +/- 13 years). Blunt injuries only were identified in 43.8% patients, while 21.9% had penetrating injuries only, and 34.3% had a combination of injury patterns. Recidivists presenting with penetrating trauma as their initial injury were more likely to return with penetrating injuries on their second (58% vs. 25% [p < 0.001]) and third (68% vs. 24% [p < 0.001]) visits. The all-cause mortality of a penetrating injury was significantly higher than that of a blunt injury for both second (9.2% vs. 1.0% [p < 0.001]) and third (15.1% vs. 1.3% [p = 0.002]) visits. The likelihood of mortality increased over twofold for each subsequent penetrating trauma visit (odds ratio [OR]; 95% confidence interval [CI]; 2.20 [1.63-2.97], p < 0.001).
  
  
  CONCLUSIONS
  Individual recidivists with penetrating injuries are likely to return with the same injury pattern, and are at increased risk of death with each subsequent visit.
authors.affiliation: Department of Surgery, Division of Trauma & Critical Care, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Brooke
authors.forename: David T
authors.initials: DT
authors.lastname: Efron
authors.forename: David C
authors.initials: DC
authors.lastname: Chang
authors.forename: Elliott R
authors.initials: ER
authors.lastname: Haut
authors.forename: Edward E
authors.initials: EE
authors.lastname: Cornwell
mesh_terms: D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission; D012008:Recurrence; D012189:Retrospective Studies; D012306:Risk; D012309:Risk-Taking; D014754:Violence; D014948:Wounds, Gunshot / Q000453:epidemiology / Q000401:mortality; D014950:Wounds, Penetrating / Q000453:epidemiology* / Q000401:mortality; D014951:Wounds, Stab / Q000453:epidemiology / Q000401:mortality