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Household Recidivism as an Environmental Risk Factor in Pediatric Trauma Recidivism
Christine J. Park, MD1; Patricia Morrell, BSN, RN-BC2; James M. Dodington, MD1; Emily R. Christison-Lagay, MD1
1Yale University, New Haven, CT; 2Yale New Haven Children's Hospital, New Haven, CT

Background: Previous studies examining trauma recidivism have focused on identifying demographic and behavioral factors which place an individual at risk for recurrent injury. Within the pediatric population, social and environmental risk factors contributing to recidivism are likely to affect not only a single individual but all members of a family. We hypothesized that household recidivism would identify a previously unstudied population of children with high risk home environments.

Methods: Electronic medical records of children 0-15 years presenting to a level 1 pediatric trauma center between 1/1/2017-12/31/2017 were reviewed. Patients with ≥2 presentations related to injury were considered recidivists. 'Household recidivists' were defined as ≥2 visits by children sharing a home address. Demographics and mechanism of injury were recorded. Chi squared test was used to assess variance with significance assumed for p<0.05.

Results: We identified 315 recidivists for a recidivism rate of 4.7%. Age displayed bimodal distribution with the highest frequency in age groups 2-4 and 9-12. Twenty-five (8.3%) recidivists had ≥3 visits. Twenty-three (7.3%) recidivists had ≥1 housemates with injury-related ED visits. 98 household recidivists were identified; 25 (25.5%) of these had ≥3 injury-related encounters by ≥2 children. Injuries from these 'high-risk' households were more likely to occur in the home (p=0.02) compared to households with ≥2 encounters.

Conclusions: Household recidivists constitute a previously unidentified group of children at increased risk of injury. This group should be included in future studies of pediatric trauma recidivism as it may extend our identification of at risk environments and help focus intervention strategies.

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