title: The prevalence of alcohol-related trauma recidivism: A systematic review.
abstract: OBJECTIVE
  Recurrent admission to a hospital or trauma centre for separate incidents of traumatic injury is known as trauma recidivism. Although use of alcohol is a known risk factor for injury and associated with trauma recidivism, the scale of alcohol-related trauma recidivism has not been well described. The purpose of this review was to search the published literature for studies that evaluated the prevalence of alcohol use among trauma recidivists. Our primary objective was to determine the proportion of trauma recidivism related to alcohol use. The association between alcohol and trauma recidivism was evaluated as a secondary objective.
  
  
  METHODS
  Four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) were searched from inception until December 2015 for all articles that might provide evidence on the proportion of trauma recidivism related to use of alcohol. After removal of duplicates, the search strategy yielded 2470 records for screening. Only primary studies that reported on repeated admissions to a hospital or trauma centre for traumatic injuries specifically related to alcohol use were included. Descriptive statistics were used to assess study characteristics and the prevalence of trauma recidivism related to alcohol use. An aggregate weighted estimate of alcohol-related trauma recidivism was calculated.
  
  
  RESULTS
  A total of 12 studies met all inclusion criteria. Studies were published between 1989 and 2014. Overall, there were 3386 trauma recidivists among included studies. The proportion of trauma recidivists with evidence of alcohol use on admission ranged from 26.7% to 76.9% (median 46.4%). The aggregated sample produced a weighted estimate of 41.0% (1388/3386) for alcohol-related trauma recidivism. In four studies, the association between alcohol and trauma recidivism was examined; all four found a positive association between alcohol use and repeated admission for traumatic injury. Studies varied considerably in design, trauma populations, periods for evaluating recidivism, definitions for positive alcohol on admission, and methods used to determine alcohol use.
  
  
  CONCLUSIONS
  Evidence from current literature suggests that 41.0% of trauma recidivism is related to use of alcohol. Due to methodological limitations among the studies included for review, this may underestimate the actual prevalence of alcohol-related trauma recidivism.
authors.affiliation: Dalhousie University Medical School, Halifax, Nova Scotia, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Nunn
authors.affiliation: Trauma Nova Scotia, Halifax, Nova Scotia, Canada.
authors.forename: Mete
authors.initials: M
authors.lastname: Erdogan
authors.affiliation: Trauma Nova Scotia, Halifax, Nova Scotia, Canada; Department of Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada. Electronic address: greenrs@dal.ca.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Green
mesh_terms: D017677:Age Distribution; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology*; D000435:Alcoholic Intoxication / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D000431:Ethanol / Q000097:blood; D006801:Humans; D008403:Mass Screening; D010359:Patient Readmission / Q000706:statistics & numerical data; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*
chemical_list: D000431:Ethanol
keywords: Alcohol; Injury; Recidivism; Systematic review; Trauma