Injury Recidivism in a Rural ED☆,☆☆,★

Presented at the Third International Conference on Injury Control, Melbourne, Australia, February 1996.
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Abstract

Study objective: To determine the degree of injury recidivism in our ED population and to identify indicators of injury recidivism. Methods: We conducted a retrospective review in a university-affiliated department of emergency medicine. The study participants were patients who presented for treatment of an injury. An injury recidivist was defined as a patient who presented for treatment of two or more unique injuries during the 1-year study period. The injured population was divided into three categories: (1) those with a single injury visit, (2) those with two to three injury visits, and (3) those with four or more injury visits. Demographics, mechanism of injury, and outcome data were collected and comparative analyses performed. Results: Of the 37,360 ED patient visits, 12,075 were injury related. Of the injury visit load, 2,838 of the 12,075 (24%) were injury recidivists. Of injured patients, 1,239 of 10,476 (12%) were recidivists. The sex distribution was similar among the groups, but the mean age decreased as the degree of recidivism increased. The degree of recidivism was higher for patients with Medicaid and for those who were uninsured. Lower mean medical charges per visit were found with increasing degree of recidivism, but the average total charges per patient increased with increasing degree of recidivism. Increasing degree of recidivism was associated with decreasing incidence of transportation-related injury but increased incidence of overexertion or intentional injuries. Conclusion: A small group of patients account for a significant proportion of ED injury visits. In comparison with injury patients seen once during the year, recidivists represent a younger population of lower socioeconomic status, and they are at increased risk of intentional injury. [Williams JM, Furbee PM, Hungerford DW, Prescott JE: Injury recidivism in a rural ED. Ann Emerg Med August 1997;30:176-180.]

Section snippets

INTRODUCTION

Injury is the leading cause of death in Americans younger than 44 years and the third leading cause of death among all age groups. Injury is the leading cause of years of potential life lost in the United States and costs the nation more than $200 billion annually.2 As many as 90% of all medically attended injuries are treated in EDs. More than one third of ED patients seek care for an injury.3, 4, 5

With the introduction of managed care, use of medical resources has received much attention.6, 7

MATERIALS AND METHODS

This project was carried out in a rural, university-affiliated ED with an annual census of approximately 38,000 patients. An ED-based injury surveillance system (EDBISS) was used prospectively to gather data on all ED patients. EDBISS has been described elsewhere.17

Patients who presented to the ED for care of an injury were identified. An injury recidivist was defined as a patient who presented for care of two or more unique injuries during the 1-year study period. To study correlates of injury

RESULTS

During the study period, 37,360 visits to our ED were made by 26,895 patients. A total of 12,075 injury-related visits were (32%) made by 10,476 patients. Of the injured patients, 12% were injury recidivists (Table 1). This group accounted for 24% of all injury-related visits.

The average number of days between visits was 85.4. Only 17% of repeat visits were found to have occurred within 4 and 14 days of the initial visit. Thus 83% of the visits were checked by hand or represented visits that

DISCUSSION

The degree of injury recidivism determined in our ED was four times greater than the rate of recurrent trauma hospitalization estimated by Smith et al11 in an urban trauma center. This may be due to the fact that our study included visits that did not result in hospitalization, as well as those that did. When we compared the percentage of recurrent trauma hospitalizations seen in our hospital over the past 2 years (26 of 2,867/26 [9%]), the figures were similar to those reported by Smith et al11

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From the Department of Emergency Medicine, Center for Rural Emergency Medicine, West Virginia University, WV;* and the Division of Acute Care, Rehabilitation Research and Disability Prevention, National Center for Injury Prevention and Control, Atlanta, GA.‡

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Reprint no.47/1/83134

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Address for reprints: Janet M Williams, MD, Department of Emergency Medicine, PO Box 9151, Morgantown, WV 26506-9151, 304-293-6682, Fax 304-293-6702

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