Saving lives and saving money

Juillard, Catherine; Smith, Randi N.; Anaya, Nancy; Garcia, Arturo; Kahn, James G.; Dicker, Rochelle

doi:10.1097/ta.0000000000000527

Cited by 87 publications

(27 citation statements)

References 11 publications

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“…There is increasing evidence that these HVIPs are effective in reducing injury recidivism. 28,32,33 These programs focus on the social circumstances of the patient and modifiable risk factors for recidivism including employment, mental health services, and substance abuse counseling. There is greatest efficacy of these programs when focusing on the highest risk populations such as trauma recidivists.…”

Section: Discussionmentioning

confidence: 99%

Trauma Recidivism Predicts Long-term Mortality

2017

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Objectives The objectives of this study were to determine the association between recurrent trauma admissions (recidivism) and subsequent long-term mortality, and to identify those in most need for preventive interventions. Background Patients with a single intentional injury have been shown to have a higher risk of future injury mortality than those with unintentional injury with 5-year mortality rates as high as 20% being reported for recurrent penetrating trauma. Trauma recidivism identifies a high-risk population, but its association with long-term mortality is largely unknown. Methods Patients with 1 or more previous admissions to an urban trauma center (recidivists) were identified and compared with those with single admissions (nonrecidivists) from 1997 to 2008. The trauma registry was linked to the National Death Index to determine both the cause and time to death after hospital discharge. Statistical analysis included chi-square tests, Kaplan-Meier survival curves, and Cox proportional-hazards models. Results Trauma recidivists were 7% of the total trauma population from 1997 to 2008, representing 3147 patients. Recidivists were more likely to be male (P < 0.0001), Black (P < 0.0001), have a blood alcohol content above 80mg/dL (P < 0.0001), and suffer a penetrating injury (P < 0.0001) compared with nonrecidivists. Recidivists with both initial blunt and penetrating injuries had higher rates of long-term mortality after discharge. Recidivists were more likely to die of any cause based on Cox proportional-hazard ratios [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.57–2.01], injury death (HR 2.02, 95% CI 1.66–2.47), and disease death (HR 1.65, 95% CI 1.41–1.92) than nonrecidivists. Conclusions Male sex, Black race, and elevated blood alcohol content and penetrating injury are associated with trauma recidivism which leads to a higher risk of death. There is a critical public health need to develop interventions to reduce trauma recidivism and preventable death.

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Section: Discussionmentioning

confidence: 99%

Trauma Recidivism Predicts Long-term Mortality

2017

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“…Due to both alcohol and previous trauma admission being associated with an increased risk of future mortality in patients who are discharged alive after fall, there is a critical need to address these modifiable risk factors to reduce preventable deaths in patients surviving the initial fall. Healthcare-based trauma recidivism and alcohol interventions have been shown to be effective encouraging the continued and expanded incorporation of these services 29, 30 .…”

Section: Discussionmentioning

confidence: 99%

Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality

Strong

Torain

Greene

et al. 2016

The American Journal of Surgery

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Background Racial disparities in trauma outcomes occur but disparities in fall mortality are unknown. Objectives To determine in-hospital and one-year fall mortality among patients discharged from an urban trauma center. Methods We conducted a retrospective analysis of fall patients in our trauma registry (1997–2008) linked to the National Death Index to determine post-discharge mortality. Statistical analysis included chi-squared tests, multivariable logistic regression and Cox proportional hazards models. Results There were 7,541 fall admissions. There was no clinically significant difference in in-hospital mortality between blacks and whites with age stratification. One year post-discharge, Blacks younger than 65 were more likely to die of disease (HR 1.37; 95% CI 1.14–1.62). Conclusion While rates of in-hospital mortality are similar, Blacks under the age of 65 have a higher risk of dying following discharge due to disease when stratified by age highlighting the need for continued medical follow up and prevention efforts.

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“…Although recurrent violent injury has been studied since the 1980s, prior studies have tracked recurrent visits limited to an individual trauma center, 7,9–16 a particular intervention or cohort study, 17–19 or a local area, 3,20,21 and many have combined results for both violent and nonviolent injuries. Most report a rate of recurrence of 10–25% over 2–5 years.…”

Section: Introductionmentioning

confidence: 99%

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

Kaufman

Rising

Wiebe

et al. 2016

The American Journal of Emergency Medicine

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Introduction Though preventing recurrent violent injury is an important component of a public health approach to interpersonal violence, and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established. Methods We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and estimated time to recurrence with the Kaplan-Meier method. We tabulated hospital charges and costs for index and recurrent visits. Results Of 53,908 patients presenting for violent injury in 2010, 11.1% had a recurrent violent injury during the study period. Trauma centers treated 31.8%, including 55.9% of severe injuries. Among recurrers, 58.9% went to a different hospital for their second injury. Low income, homelessness, Medicaid or uninsurance, and Black race were associated with increased odds of recurrence. Patients with visits for mental and behavioral health and unintentional injury also had increased odds of recurrence. Index injuries accounted for $105 million in costs, and recurrent injuries accounted for another $25.3 million. Conclusions Recurrent violent injury is a common and costly phenomenon, and effective violence prevention programs are needed. Prevention must include the non-trauma centers where many patients seek care.

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Saving lives and saving money

Abstract: Economic and value-based evaluation, level 2.

Cited by 87 publications

References 11 publications

Trauma Recidivism Predicts Long-term Mortality

Trauma Recidivism Predicts Long-term Mortality

Outcomes of trauma admission for falls: influence of race and age on inhospital and post-discharge mortality

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis

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