Violent trauma recidivism: Does all violence escalate?
OBJECTIVE
Rates of trauma patients presenting with history of prior trauma range from 25 to 44%. Outcomes involving recidivists in the setting of intentional trauma, especially penetrating trauma, are conflicting. We hypothesized that if violence does escalate with successive incidence, then injuries due to successive violence should escalate or become increasingly severe with successive admissions.


METHODS
The trauma registry from an urban level I adult and pediatric trauma center was queried for injuries due to blunt assault, stabbing, and firearm injury. Primary outcome measures were mortality, injury mechanism, and injury severity for each successive trauma admission.


RESULTS
Victims of blunt assault and stabbing were more likely to become recidivists than victims of gun violence (OR 1.53, p < 0.001 and OR 1.57, p < 0.001). Violent re-injury became increasingly severe only in victims of repeated gun violence. Patients with gunshot as the mechanism at every admission are at highest risk for mortality (OR 13.48, p < 0.001). All but one mortality (95.8%) in the recidivist population occurred within 180 days of discharge from a prior injury.


CONCLUSIONS
Recidivism for interpersonal violence results in a significant number of admissions to trauma centers. In our patient cohort, injury associated with successive blunt assaults did not worsen with subsequent admissions. Recidivism for gunshot wounds tends to be more severe and have a worse prognosis with each successive admission compared to outcomes associated with repeated stab wounds. Focused efforts should include rehabilitation efforts early in the post-injury period, especially in patients with a history of gunshot wounds.
Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA. rachel.nygaard@hcmed.org.
R M
RM
Nygaard
Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA.
A P
AP
Marek
Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA.
S R
SR
Daly
Department of Surgery, Hennepin County Medical Center, 701 Park Ave S, P5, Minneapolis, MN, 55415, USA.
J M
JM
Van Camp
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D000075665:Recidivism; D012042:Registries; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014754:Violence; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000209:etiology; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
Intentional trauma; Recidivism; Repeat trauma; Trauma; Violent injury