title: Urban versus rural trauma recidivism: is there a difference?
abstract: OBJECTIVE
  Understanding the characteristics of trauma recidivists may allow trauma centers to tailor prevention programs. We hypothesized that there would be an increased incidence of violent injuries and falls in the urban vs. rural recidivists, respectively.
  
  
  METHODS
  Trauma admissions from 2000 to 2011 were queried for incidences of recidivism. Age (<65 or ≥65 years), gender, Injury Severity Score (ISS, <9 or ≥9), mortality, and injury cause (fall, violence, or other) were analyzed with univariate analyses to test for differences between urban and rural patients. Significant variables were then included in a binary logistic model and further stratified based on environment.
  
  
  RESULTS
  There were a total of 19,600 trauma admissions from 2000 to 2011, representing 18,711 unique patients, with 1,690 admissions (8.6 %) attributed to 801 recidivists (4.3 %). The overall percentages of recidivist trauma admissions attributed to urban and rural patients were 8.6 and 6.9 %, respectively (p < 0.001). When adjusting for age ≥65 years as well as falls and violent injuries, patients from urban environments were at 1.12 times higher odds of being a recidivist than their rural counterparts [odds ratio (OR) 1.12; 95 % confidence interval (CI) 1.01-1.25; p = 0.039]. When stratified into rural and urban groups, falls and violent injuries were significant in both groups of recidivist admissions; however, age ≥65 years was only significant in rural recidivist admissions.
  
  
  CONCLUSIONS
  An urban trauma admission had 12 % higher odds of being attributed to a recidivist than its rural counterpart, when controlling for age and mechanism of injury (MOI). Age ≥65 years was a significant variable in rural but not urban recidivist admissions. Characterizing the recidivist may allow for targeted prevention and intervention programs to decrease repeat hospital visits.
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. amelia.rogers@jefferson.edu.
authors.forename: A
authors.initials: A
authors.lastname: Rogers
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. mahorst@lghealth.org.
authors.forename: M
authors.initials: M
authors.lastname: Horst
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. kr061@lghealth.org.
authors.forename: K
authors.initials: K
authors.lastname: Rittenhouse
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. tto@mail.usciences.edu.
authors.forename: T
authors.initials: T
authors.lastname: To
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. sagibson@lghealth.org.
authors.forename: S
authors.initials: S
authors.lastname: Gibson
authors.affiliation: Trauma Center at Penn, University of Pennsylvania, Philadelphia, PA, USA. Charles.Schwab@uphs.upenn.edu.
authors.forename: C W
authors.initials: CW
authors.lastname: Schwab
authors.affiliation: Lancaster General Hospital, 555 N. Duke St., Lancaster, PA, 17602, USA. frogers2@lghealth.org.
authors.forename: F
authors.initials: F
authors.lastname: Rogers
keywords: Recidivism; Rural trauma; Urban trauma; Violence
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