title: The burden of terrorism: high rate of recurrent hospital referrals.
abstract: BACKGROUND
  Recurrent emergency room referrals and re-hospitalisation of terror victims (external cause of injury E990-E998 and selected cases from E970-E978) [International Classification of Diseases, 9th revision. Clinical modification, 5th ed. (ICD-9-CM). Los Angeles, CA: Practice Management Information Corporation; 1998] have not as yet been examined in the literature. Our objective was to evaluate the extent of hospital services' usage following a terror event and to characterise the casualties who return for hospitalisation and rehabilitation following their discharge.
  
  
  METHODS
  A retrospective longitudinal study including all terror victims who were hospitalised at our level I trauma centre between October 2000 and March 2004. Data on the first hospitalisation of these victims (n=497 cases) were retrieved from the hospital's trauma registry. Data on recurrent emergency room referrals and re-hospitalisation of the 464 cases who survived were taken from the hospital's administrative computerised database.
  
  
  RESULTS
  Four hundred and ninety-seven terror victims were hospitalised, of which 464 survived their first hospitalisation. Two hundred and nineteen (47%) were subsequently re-referred to the hospital. The total number of recurrent hospital referral days amounted to 77% of the total first hospitalisation days for all casualties. A strong association was found with regard to severity of injury, length of stay in the intensive care unit (ICU) and total length of stay. Logistic regression analysis found total length of stay of initial hospitalisation as the only significant variable.
  
  
  CONCLUSIONS
  The recurrent hospitalisation of terror victims places a heavy burden on the health system. Further studies should be conducted to determine the reasons for these recurrent referrals and to explore whether the number of recurrent referrals can be reduced or at least planned for.
authors.affiliation: Epidemiology and Trauma, Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel.
authors.forename: Malka
authors.initials: M
authors.lastname: Avitzour
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
authors.forename: Meir
authors.initials: M
authors.lastname: Liebergall
authors.forename: Rami
authors.initials: R
authors.lastname: Mosheiff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000453:epidemiology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D004189:Disaster Planning / Q000592:standards; D004636:Emergency Service, Hospital; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007557:Israel / Q000453:epidemiology; D008297:Male; D023481:Terrorism / Q000706:statistics & numerical data*; D016896:Treatment Outcome