Pediatric Trauma Society

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Repeat Offenders: Trauma Recidivism Has A Bimodal Age Distribution And Is Increased In Victims Of Inflicted Injuries
Christine M Leeper, Christine McKenna, *Barbara A Gaines
Children's Hospital of Pittsburgh of UPMC, pittsburgh, PA

Background (issue): Known predictors of trauma recidivism in childhood include older age, alcohol use, and penetrating injury; studies to date focus on at-risk adolescents. We hypothesize that inflicted injury (including child abuse, assault and self-harm) at any age increases risk for repeated admissions.
Methods: Children age<18 admitted to our academic level 1 pediatric trauma center database (2000-2017) were included. Recidivists were identified by medical record number. Demographics, injuries, laboratory studies, mechanism and injury severity were recorded. Chi-square/Fisher exact, Wilcoxon rank sum, and Kruskal-Wallis tests were used for between group comparisons, and multivariable logistic regression modeling was performed to determine predictors of recidivism.
Findings: 27, 186 unique patients were included: 504 (1.85%) recidivists were identified: 472 with one later admission, 28 with two later admission, and 4 with three later admissions. Median (IQR) time to recidivism was 2(1-3) years. Variables associated with recidivism included Black/African-American race (p=0.005) and alcohol use (p=0.044). Age as a continuous variable was not significant; however, a bimodal age distribution was evident, with peaks in infancy/early childhood and adolescence (Figure). Associated mechanisms included child abuse and assault (p=0.047). The proportion of patients with inflicted injuries increased in subsequent admissions (p = 0.010).
Conclusions (implications for practice): Both adolescents and young children are at risk for trauma recidivism, particularly those who present after inflicted injury. Providers should identify at-risk families and target interventions appropriately, as missing this opportunity may result in repeated admissions.


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