Repeat victims of violence are overwhelming urban trauma centers, yet little is written about them in the medical literature. This study combined medical record and survey data to study urban trauma recidivism among patients presenting at the Emergency Department [ED] of St. Elizabeth Hospital in Youngstown, Ohio during a 4-year period. Two-fifths of urban trauma patients were repeat victims. Repeat victims were more likely to be poor African-American males, have substance abuse and mental health problems, and live in neighborhoods where violence is pervasive. Most have no health insurance. Demographic characteristics were less important in explaining recidivism than were the circumstances surrounding violent behaviors. ED physicians must be trained to take into account a wide variety of environmental, personal, and circumstantial factors in treating and managing urban trauma patients. This may require reforms in health care financing.