Magnitude and Risk Factors of Pediatric Traumatic Recidivism from the First Statewide Analysis
Usman Aslam, MPH, MS1; Marcelo Cerullo, MD2 , Seth Goldstein, MD, MPhil3, Joseph Canner, MHS3; Isam W. Nasr, MD3
1Johns Hopkins University Bloomberg School of Public Health, Selden, NY; 2Duke Department of Surgery, Durham, NC; 3Johns Hopkins School of Medicine, Department of Surgery, Baltimore, MD
Background: Trauma recidivism has not been well described with population-level studies in minors and young adults. In this comprehensive statewide analysis, we assess the incidence and risk factors for trauma recidivism in pediatric patients.
Methods: Children <15 years old presenting with any traumatic injury 2012-2015 were identified using the Maryland Health Services Cost Review Commission database and followed for a minimum of two years. Demographic and injury-specific variables were assessed as potential risk factors in both the first-time visit and follow-up period using multivariable logistic regression.
Results: Exactly 192,888 patients were identified, of which 32,630 (16.9%) re-presented with one (13.3%), two (2.7%) or three or more (1.0%) new injuries after their index injury. Median time-to-recurrence was 267ds (122-474). Variables significantly associated with recidivism were African-American race, age 10-14, penetrating (versus blunt) injury, a bicycle-related injury, and any visit during the study period for either abuse, assault, or mental health. The highest adjusted odds ratios [OR(95% CI)] were for children with substance abuse related visits [1.94(1.25 - 3.00)] and residing in areas with the lowest quintile of median household incomes [1.41(1.35 - 1.47)].
Conclusions: Pediatric trauma recidivism has yet to be characterized at a population level. Our findings highlight an overall recidivism rate of nearly 17%, which is markedly higher than reports from single-institution series. Furthermore, these findings underscore the need for targeted screening and anticipatory guidance that explicitly addresses safety concerns regarding subsequent events, and may be best suited for children from low-income households or with a history substance abuse.
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