title: Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis.
abstract: BACKGROUND
  Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.
  
  
  METHODS
  We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits.
  
  
  RESULTS
  Of 53 908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million.
  
  
  CONCLUSIONS
  Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the nontrauma centers where many patients seek care.
authors.affiliation: Department of Surgery, New York-Presbyterian Hospital Weill Cornell Medical Center, New York, NY. Electronic address: elinore@mail.med.upenn.edu.
authors.forename: Elinore
authors.initials: E
authors.lastname: Kaufman
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Kristin
authors.initials: K
authors.lastname: Rising
authors.affiliation: Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.affiliation: Division of Acute Care Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL.
authors.forename: David J
authors.initials: DJ
authors.lastname: Ebler
authors.affiliation: Department of Surgery, University of Florida College of Medicine Jacksonville, Jacksonville, FL.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Crandall
authors.affiliation: Department of Emergency Medicine and Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: M Kit
authors.initials: MK
authors.lastname: Delgado
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D005431:Florida / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D017722:Hospital Charges / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D017057:Medically Uninsured / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D011203:Poverty / Q000706:statistics & numerical data*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014481:United States; D014754:Violence / Q000191:economics / Q000517:prevention & control / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D055815:Young Adult