Panamerican Journal of Trauma, Critical Care & Emergency Surgery

Register      Login

VOLUME 8 , ISSUE 3 ( September-December, 2019 ) > List of Articles

RESEARCH ARTICLE

Prior Emergency Department Utilization as a Predictor for Severe Penetrating Trauma: A Retrospective Cohort Study

Michael Goodman, Stephen R Pitts

Keywords : Cohort study, Emergency medicine, Injury epidemiology, Injury prevention, Penetrating injuries, Violence

Citation Information : Goodman M, Pitts SR. Prior Emergency Department Utilization as a Predictor for Severe Penetrating Trauma: A Retrospective Cohort Study. Panam J Trauma Crit Care Emerg Surg 2019; 8 (3):170-175.

DOI: 10.5005/jp-journals-10030-1256

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: While extensive research has been conducted on healthcare utilization after severe penetrating trauma events, there is a dearth of information on healthcare utilization prior to these events. This study examined the emergency department (ED) utilization patterns to determine if prior ED visits for injury were a risk factor for severe penetrating trauma. Materials and methods: This retrospective cohort study examined the ED visit records of 215,800 patients with 489,800 ED visits and 3,322 trauma registry patients from November 2010 to February 2015 at Grady Memorial Hospital, a large, urban hospital with a level I trauma center. Data analysis was conducted using logistic regression and Cox proportional hazard models. Results: Among 215,800 ED patients, 224 patients with prior ED visits experienced severe penetrating trauma (as reported to the trauma registry). After adjustment for age, sex, employment, insurance, high utilization, and admission status, prior ED visits for injury were associated with severe penetrating trauma (OR 1.60, CI 1.21–2.10, p = 0.001). Cox proportional hazard models were used to estimate hazard ratios (HR) for factors associated with time to a penetrating trauma event following a patient\'s last ED visit. After adjusting for age, sex, employment status, admission status, high utilization, and insurance status, patients with an injury diagnosis at their last ED visit had a HR of 1.43 (CI 1.07–1.93, p = 0.016). Conclusion: After adjusting for confounders, a previous ED visit for injury remained a significant risk factor for severe penetrating trauma and an elevated rate of time to penetrating trauma. These findings suggest a need for targeted violence intervention programs and improved ED injury surveillance.


PDF Share
  1. Fowler KA, Dahlberg LL, Haileyesus T, et al. Firearm injuries in the United States. Prev Med 2015;79:5–14. DOI: 10.1016/j.ypmed.2015.06.002.
  2. Kalesan B, Adhikarla C, Pressley JC, et al. The hidden epidemic of firearm injury: increasing firearm injury rates during 2001-2013. Am J Epidemiol 2017;185(7):546–553. DOI: 10.1093/aje/kww147.
  3. Jena AB, Sun EC, Prasad V. Does the declining lethality of gunshot injuries mask a rising epidemic of gun violence in the United States? J Gen Intern Med 2014;29(7):1065–1069. DOI: 10.1007/s11606-014-2779-z.
  4. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. 2005. www.cdc.gov/injury/wisqars. Accessed 2017 April 3.
  5. Tracy M, Braga AA, Papachristos AV. The transmission of gun and other weapon-involved violence within social networks. Epidemiol Rev 2016;38(1):70–86. DOI: 10.1093/epirev/mxv009.
  6. Wells W, Chermak S. Individual-level risk factors for gun victimization in a sample of probationers. J Interpers Violence 2011;26(11): 2143–2164. DOI: 10.1177/0886260510383022.
  7. Haegerich TM, Dahlberg LL, Simon TR, et al. Prevention of injury and violence in the USA. Lancet 2014;384(9937):64–74. DOI: 10.1016/S0140-6736(14)60074-X.
  8. Henrich CC, Brookmeyer KA, Shahar G. Weapon violence in adolescence: parent and school connectedness as protective factors. J Adolesc Health 2005;37(4):306–312. DOI: 10.1016/j.jadohealth.2005.03.022.
  9. Tolan PH, Gorman-Smith D, Henry D, et al. The benefits of booster interventions: evidence from a family-focused prevention program. Prev Sci 2009;10(4):287–297. DOI: 10.1007/s11121-009-0139-8.
  10. Henneberger AK, Varga SM, Moudy A, et al. Family functioning and high risk adolescents’ aggressive behavior: examining effects by ethnicity. J Youth Adolesc 2016;45(1):145–155. DOI: 10.1007/s10964-014-0222-8.
  11. Chong VE, Lee WS, Victorino GP. Neighborhood socioeconomic status is associated with violent reinjury. J Surg Res 2015;199(1):177–182. DOI: 10.1016/j.jss.2015.03.086.
  12. Shetgiri R, Boots DP, Lin H, et al. Predictors of weapon-related behaviors among African American, Latino, and White Youth. J Pediatr 2016;171:277–282. DOI: 10.1016/j.jpeds.2015.12.008.
  13. Ruback RB, Shaffer JN, Clark VA. Easy access to firearms: juveniles’ risks for violent offending and violent victimization. J Interpers Violence 2011;26(10):2111–2138. DOI: 10.1177/0886260510372948.
  14. Papachristos AV, Hureau DM, Braga AA. The Corner and the Crew: the influence of geography and social networks on gang violence. Am Sociol Rev 2013;78(3):417–447. DOI: 10.1177/0003122413486800.
  15. Kennedy DM, Piehl AM, Braga AA. Youth violence in Boston: gun markets, serious youth offenders, and a use-reduction strategy. Law Contemp Prob 1996;59(1):147–196. DOI: 10.2307/1192213.
  16. Wiebe DJ, Richmond TS, Guo W, et al. Mapping activity patterns to quantify risk of violent assault in urban environments. Epidemiology 2016;27(1):32–41. DOI: 10.1097/EDE.0000000000000395.
  17. Lipton R, Yang X, Braga AA, et al. The geography of violence, alcohol outlets, and drug arrests in Boston. Am J Public Health 2013;103(4):657–664. DOI: 10.2105/AJPH.2012.300927.
  18. Beard JH, Morrison CN, Jacoby SF, et al. Quantifying disparities in urban firearm violence by race and place in Philadelphia, Pennsylvania: a cartographic study. Am J Public Health 2017;107(3):371–373. DOI: 10.2105/AJPH.2016.303620.
  19. Braga AA, Papachristos AV, Hureau DM. The concentration and stability of gun violence at micro places in Boston, 1980-2008. J Quant Criminol 2010;26(1):33–53. DOI: 10.1007/s10940-009-9082-x.
  20. Green B, Horel T, Papachristos AV. Modeling contagion through social networks to explain and predict gunshot violence in Chicago, 2006 to 2014. JAMA Intern Med 2017;177(3):326–333. DOI: 10.1001/jamainternmed.2016.8245.
  21. Papachristos AV, Braga AA, Hureau DM. Social networks and the risk of gunshot injury. J Urban Health 2012;89(6):992–1003. DOI: 10.1007/s11524-012-9703-9.
  22. Papachristos AV, Wildeman C. Network exposure and homicide victimization in an African American community. Am J Public Health 2014;104(1):143–150. DOI: 10.2105/AJPH.2013.301441.
  23. Sumner SA, Mercy JA, Dahlberg LL, et al. Violence in the United States: status, challenges, and opportunities. JAMA 2015;314(5):478–488. DOI: 10.1001/jama.2015.8371.
  24. Cunningham RM, Carter PM, Ranney M, et al. Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr 2015;169(1):63–70. DOI: 10.1001/jamapediatrics.2014.1900.
  25. Smith R, Dobbins S, Evans A, et al. Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg 2013;74(4):976–980; discussion 980–972 10.1097/TA.0b013e31828586c9.
  26. Chong VE, Smith R, Garcia A, et al. Hospital-centered violence intervention programs: a cost-effectiveness analysis. Am J Surg 2015;209(4):597–603. DOI: 10.1016/j.amjsurg.2014.11.003.
  27. Shibru D, Zahnd E, Becker M, et al. Benefits of a hospital-based peer intervention program for violently injured youth. J Am Coll Surg 2007;205(5):684–689. DOI: 10.1016/j.jamcollsurg.2007.05.029.
  28. Bank ANTD. National Trauma Data Standard: Data Dictionary 2014 (2015 Admissions).
  29. Rowhani-Rahbar A, Zatzick D, Wang J, et al. Firearm-related hospitalization and risk for subsequent violent injury, death, or crime perpetration: a cohort study. Ann Intern Med 2015;162(7):492–500. DOI: 10.7326/M14-2362.
  30. Brooke BS, Efron DT, Chang DC, et al. Patterns and outcomes among penetrating trauma recidivists: it only gets worse. J Trauma 2006;61(1):16–19.; discussion 20 10.1097/01.ta.0000224143.15498.bb.
  31. McCoy AM, Como JJ, Greene G, et al. A novel prospective approach to evaluate trauma recidivism: the concept of the past trauma history. J Trauma Acute Care Surg 2013;75(1):116–121. DOI: 10.1097/TA.0b013e31829231b7.
  32. Vassar MJ, Kizer KW. Hospitalizations for firearm-related injuries. A population-based study of 9562 patients. JAMA 1996;275(22): 1734–1739. DOI: 10.1001/jama.1996.03530460038028.
  33. Carter PM, Walton MA, Roehler DR, et al. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics 2015;135(5):805–815. DOI: 10.1542/peds. 2014-3572.
  34. Aboutanos MB, Jordan A, Cohen R, et al. Brief violence interventions with community case management services are effective for high-risk trauma patients. J Trauma 2011;71(1):228–236; discussion 236–227 10.1097/TA.0b013e31821e0c86.
  35. Purtle J, Dicker R, Cooper C, et al. Hospital-based violence intervention programs save lives and money. J Trauma Acute Care Surg 2013;75(2):331–333. DOI: 10.1097/TA.0b013e318294f518.
  36. Duncan TK, Waxman K, Romero J, et al. Operation Peace Works: a community program with the participation of a level II trauma center to decrease gang-related violence. J Trauma Acute Care Surg 2014;76(5):1208–1213. DOI: 10.1097/TA.0000000000000179.
  37. Cheng TL, Haynie D, Brenner R, et al. Effectiveness of a mentor-implemented, violence prevention intervention for assault-injured youths presenting to the emergency department: results of a randomized trial. Pediatrics 2008;122(5):938–946. DOI: 10.1542/peds.2007-2096.
  38. Walton MA, Chermack ST, Shope JT, et al. Effects of a brief intervention for reducing violence and alcohol misuse among adolescents: a randomized controlled trial. JAMA 2010;304(5):527–535. DOI: 10.1001/jama.2010.1066.
  39. Sharp AL, Prosser LA, Walton M, et al. Cost analysis of youth violence prevention. Pediatrics 2014;133(3):448–453. DOI: 10.1542/peds.2013-1615.
  40. Jaycox LH, Marshall GN, Schell T. Use of mental health services by men injured through community violence. Psychiatr Serv 2004;55(4): 415–420. DOI: 10.1176/appi.ps.55.4.415.
  41. Florence C, Shepherd J, Brennan I, et al. Effectiveness of anonymised information sharing and use in health service, police, and local government partnership for preventing violence related injury: experimental study and time series analysis. BMJ 2011;342:d3313. DOI: 10.1136/bmj.d3313.
  42. Boyle AA, Snelling K, White L, et al. External validation of the Cardiff model of information sharing to reduce community violence: natural experiment. Emerg Med J 2013;30(12):1020–1023. DOI: 10.1136/emermed-2012-201898.
  43. Kaufman E, Rising K, Wiebe DJ, et al. Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis. Am J Emerg Med 2016;34(9):1823–1830. DOI: 10.1016/j.ajem.2016.06.051.
  44. Haider AH, Young JH, Kisat M, et al. Association between intentional injury and long-term survival after trauma. Ann Surg 2014;259(5): 985–992. DOI: 10.1097/SLA.0000000000000486.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.