title: Rural trauma recidivism: a different disease.
abstract: OBJECTIVE
  Unlike the well-characterized urban trauma recidivist (RC), factors associated with the rural RC remain undefined. In an attempt to devise preventative strategies, we theorized that the rural RC profile would be similar to that of urban counterparts.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Rural, university-affiliated, level I trauma center.
  
  
  METHODS
  All trauma patients admitted between January 1, 1994, and December 30, 2002.
  
  
  METHODS
  Identification and characterization of rural trauma RCs.
  
  
  METHODS
  Trauma recidivism incidence, risk factors, and cost.
  
  
  RESULTS
  Of 15 370 consecutive admissions, 528 (3.4%) were RCs. Demographic comparisons to a non-RC cohort demonstrated rural RCs to be significantly older (mean +/- SD age, 55.9 +/- 24.8 vs 39.7 +/- 24.1 years), disproportionately white (65.2% [344/528] vs 56.5% [8386/14 842]), and more likely female (49.1% [259/528] vs 37.3% [5537/14 842]) (P<.001 for all). Clinical comparisons revealed significant associations between recidivism and substance abuse. The percentage of positive blood ethanol screen results (58.7% [310/528] vs 39.9% [5923/14 842]) and the mean +/- SD blood ethanol content (132.1 +/- 139.9 mg/dL [28.7 +/- 30.4 mmol/L] vs 69.5 +/- 114.4 mg/dL [15.1 +/- 24.8 mmol/L]) were higher for RCs (P<.001 for both). In addition, cocaine use was significantly higher in the RC cohort (6.4% [34/528] vs 4.1% [607/14 842]; P=.02). The total cost for all RC admissions exceeded $7 million.
  
  
  CONCLUSIONS
  The rural RC profile is strikingly different from urban counterparts. The common feature seems to be substance abuse. Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations.
authors.affiliation: Department of Surgery, The Brody School of Medicine at East Carolina University, University Health Systems of Eastern North Carolina, 600 Moye Boulevard, Greenville, NC 27858, USA. etoschlo@pcmh.com
authors.forename: Eric A
authors.initials: EA
authors.lastname: Toschlog
authors.forename: Scott G
authors.initials: SG
authors.lastname: Sagraves
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bard
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Schenarts
authors.forename: Claudia C
authors.initials: CC
authors.lastname: Goettler
authors.forename: Mark A
authors.initials: MA
authors.lastname: Newell
authors.forename: Michael F
authors.initials: MF
authors.lastname: Rotondo
mesh_terms: D000328:Adult; D000428:Alcohol Drinking; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*