Frequency of Recidivism in Patients With Orthopedic Trauma

Abstract

The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].

Comorbid tobacco and other substance use and symptoms of anxiety and depression among hospitalised orthopaedic trauma patients

“…Previous research also indicates that rates of hazardous alcohol and recent cannabis use are high in the orthopaedic trauma population [12]. In addition, orthopaedic trauma patients who are readmitted to hospital are more likely to use tobacco, alcohol and other drugs, indicating the need to address the comorbidities within the orthopaedic trauma population [13]. As far as the authors are aware, rates of smoking, alcohol and cannabis use, and symptoms of depression and anxiety have yet to be assessed in the one study among orthopaedic trauma patients.…”

“…We hypothesise that addressing comorbid health conditions of tobacco smoking (such as other substance use or mental ill-health) when providing smoking cessation care in this setting may: a) improve the health outcome of patients faster, given the negative health impact substance use and mental ill-health can have on recovery; [1–3] and b) decrease health care costs and lengths of hospital admissions, given continued substance use may result in readmission or longer hospital stays, [20] and that are readmitted to hospital are more likely to use substances [13] .…”

The role of sociodemographics in the occurrence of orthopaedic trauma

“…Higher levels of unemployment, poverty, and transiency in combination with lower levels of economic opportunity, community participation, neighborhood development, and gang activity are community-level risk factors for violence [56][57][58]. Patients with penetrating injuries have an increased risk of mortality and of returning with the same injury pattern [59]. The incidence of penetrating trauma may be considered an indicator of elevated risk for excessive violence exposure and not a random event.…”

Burn recidivism: a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States

“…Recurrent injuries requiring medical treatment contribute to growing healthcare costs and increased mortality rates [11, 14, 15]. Consequently, investigators have sought to identify sociodemographic, clinical, and injury-specific patterns among trauma recidivists [12, 16–19] as a means to guide intervention and prevention strategies among this high-risk population. The risk factors most strongly associated with a primary traumatic injury—young age, male gender, lack of insurance, psychiatric disorders, and substance use disorders—are also associated with a primary burn injury [3, 4, 20, 21].…”

“…When a patient has comorbid psychiatric and/or substance use disorder, the rate of trauma recidivism has been found to increase two to threefold (40–60%) [5, 6, 22, 23]. Mechanisms of injuries found to be associated with recidivism include GSWs/stabbings [8, 16], falls [7, 23], assaults [16, 23, 24], and MVCs [8, 23]. Previous studies of trauma recidivism, however, generally exclude burn-injured patients [5, 8, 9, 12, 24]; when included, burn-injured patients account for less than 3% of the study population [7, 17, 23, 25].…”