Characteristics of the trauma recidivist: An exploratory descriptive study

doi:10.1067/men.2001.116214

Journal of Emergency Nursing

Volume 27, Issue 4, August 2001, Pages 340-346

https://doi.org/10.1067/men.2001.116214 Get rights and content

Abstract

Introduction: The purpose of this study was to identify characteristics and perceptions of trauma recidivists. Information obtained from this study will help health care professionals better understand trauma patients and design more effective trauma prevention programs. Methods: An exploratory descriptive, correlational design was used. A convenience sample of 100 trauma patients entering a midwestern university medical center were studied. A demographic chart review and a personal interview consisting of 29 questions were conducted for each subject. The interview questions sought information regarding high-risk behavior, risk-taking personality traits, safety precautions used, and social, psychological, and environmental factors surrounding the patient's traumatic event. Results: Thirty-six percent of trauma patients studied were recidivists. The recidivist was more likely to be male, younger than 45 years, a member of a racial minority, single, uninsured, and have less than 12 years of education. Behavioral characteristics common to most recidivists included a history of past arrests, illegal drug use, and having witnessed past violent injuries. Discussion: Trauma remains one of the most devastating diseases facing americans. Characteristics of trauma recidivists have been identified, and further research is needed to test possible interventions to curb the unnecessary trauma injuries that occur every day.

J Emerg Nurs 2001;27:340-6.

Section snippets

Method

An exploratory, descriptive comparative correlational design and a semistructured interview technique were used to examine the characteristics of trauma patients, both recidivists and nonrecidivists. A convenience sample of 100 trauma patients admitted to a large midwestern university medical center trauma unit were interviewed to determine eligibility to enter the study. Criteria were as follows: the patient was 18 years or older; the patient's injury met the criteria for trauma triage

Findings

The convenience sample consisted of 100 trauma patients admitted to a suburban midwestern university level I trauma center between September 1997 and January 1998. The majority of the trauma subjects were younger than 45 years, male, white, and single, with a high school education. Only 12% of the general trauma sample was reported to be Hispanic. The majority of the subjects had incomes between $10,000 and $40,000, and 50% were privately insured (Figure 1).

. Recidivists versus nonrecidivists:

Limitations

Several limitations of this study need to be addressed. The study included a convenience sample of 100 trauma patients and was conducted in one institution and in one geographic area of the United States. The period of this study was 5 months and looked back on only 5 years of traumatic injuries. Because no interpreter was available, the non-English speaking population may have been underrepresented. Patients younger than 18 years were not included. These limitations hamper the generalizability

Discussion

Although recidivism has been characterized as a problem among trauma centers nationwide, the magnitude of the problem has not been quantified. This study has demonstrated a 36% prevalence of recidivists in the sample population, which is comparable with data from previous studies that reported an average recidivist rate of 35%.1, 2, 4, 5, 8 Most of the previous studies reporting recidivism rates have been conducted in urban centers1, 2, 5, 8; however, one rural study cited a recidivism rate of

Conclusion

This study provides information about some of the characteristics of trauma patients and trauma recidivists. Recidivism occurs at all types of trauma centers: urban, rural, and suburban. The recidivists are generally single men younger than 45 years and members of a racial minority. They usually have less education than the general trauma population and are likely to be uninsured. Finally, recidivists are also more likely to have been injured in a violent incident, to have positive results of a

Implication for nurses

This study has many implications for nurses involved in caring for trauma patients. At the beginning of this study we asked the question, “What is the recidivist rate among the suburban population of trauma patients?” We discovered that suburban recidivist rates are similar to those of urban centers. Nurses should use this knowledge to inform patients that they have approximately a 40% chance of becoming a trauma patient again if they do not alter the behavior that caused their initial injury.

Acknowledgements

We would like to thank Michelle Pry and Dr Thomas Esposito for their invaluable assistance with this project.

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Cited by (16)

Treating trauma more effectively: A review of psychosocial programming
2022, Injury
Citation Excerpt :
Studies have reported rates from 18%−36%, within the first years following another injury [27,49,50]. Recidivists are more likely to be male, unmarried, and unemployed [49]. Independent factors associated with recidivism are Medicaid insurance or lack of insurance, and history of gunshot wound or assault [50].
Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation.
Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented.
The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
A systematic review of socioeconomic status measurement in 13 years of U.S. injury research
2018, Journal of Safety Research
The purpose of this review was to assess the impact of socioeconomic status (SES) on injury and to evaluate how U.S. injury researchers have measured SES over the past 13 years in observational research studies.
This systematic review included 119 US injury studies indexed in PubMed between January 1, 2002 and August 31, 2015 that used one or more individual and/or area-level measures of SES as independent variables. Study findings were compared to the results of a previous review published in 2002.
Findings indicate SES remains an important predictor of injury. SES was inversely related to injury in 78 (66%) of the studies; inverse relationships were more consistently found in studies of fatal injury (77.4%) than in studies of non-fatal injury (58%). Approximately two-thirds of the studies (n = 73, 61%) measured SES along a gradient and 59% used more than one measure of SES (n = 70). Studies that used a gradient measure of SES and/or more than one measure of SES identified significant relationships more often. These findings were essentially equivalent to those of a similar 2002 review (Cubbin & Smith, 2002).
There remains a need to improve measurement of SES in injury research. Public health training programs should include best practices for measurement of SES, which include: measuring SES along a gradient, selecting SES indicators based on the injury mechanism, using the smallest geographic region possible for area-level measures, using multiple indicators when possible, and using both individual and area-level measures as both contribute independently to injury risk. Area-level indicators of SES are not accurate estimates of individual-level SES.
Injury researchers should measure SES along a gradient and incorporate individual and area-level SES measures that are appropriate to the injury outcome under study.
Violent reinjury risk assessment instrument (VRRAI) for hospital-based violence intervention programs
2017, Journal of Surgical Research
Citation Excerpt :
Traditionally, prediction models in IPV, suicide risk, and violent reinjury have been classified into three categories: unstructured clinical judgment, actuarial risk assessment, and structured professional judgment (SPJ).15 Although several studies have used actuarial approaches to quantify the risk factors associated with injury recidivism,4,32-35 SPJ remains the favored approach and is the form that the VRRAI takes.15 SPJ has been defined as “a decision made without fixed and explicit rules but based at least in part in consideration of a standardized information base”.36
Violent injury is the second most common cause of death among 15- to 24-year olds in the US. Up to 58% of violently injured youth return to the hospital with a second violent injury. Hospital-based violence intervention programs (HVIPs) have been shown to reduce injury recidivism through intensive case management. However, no validated guidelines for risk assessment strategies in the HVIP setting have been reported. We aimed to use qualitative methods to investigate the key components of risk assessments employed by HVIP case managers and to propose a risk assessment model based on this qualitative analysis.
An established academic hospital-affiliated HVIP served as the nexus for this research. Thematic saturation was reached with 11 semi-structured interviews and two focus groups conducted with HVIP case managers and key informants identified through snowball sampling. Interactions were analyzed by a four-member team using Nvivo 10, employing the constant comparison method. Risk factors identified were used to create a set of models presented in two follow-up HVIP case managers and leadership focus groups.
Eighteen key themes within seven domains (environment, identity, mental health, behavior, conflict, indicators of lower risk, and case management) and 141 potential risk factors for use in the risk assessment framework were identified. The most salient factors were incorporated into eight models that were presented to the HVIP case managers. A 29-item algorithmic structured professional judgment model was chosen.
We identified four tiers of risk factors for violent reinjury that were incorporated into a proposed risk assessment instrument, VRRAI.
Risk factors for recurrent violent injury among black men
2016, Journal of Surgical Research
Black men are disproportionately overrepresented among victims of repeat violent injury. However, little is known about the risk factors that influence violent trauma recidivism among black men. We hypothesize that the following risk factors would be significant among black male victims of repeat violent injury: disrespect; being under the influence; being in a fight and using a weapon in the past year; and previous incarceration when comparing trauma recidivists versus nonrecidivists.
Using secondary data analysis, we identified a sample of 191 (n = 191) urban low-income black men treated by a level I trauma unit in Baltimore for violent injury (e.g., gunshot wound, stabbing, or assault) who participated in a hospital-based violence intervention program from 1998 to 2011. Participants in the program completed a risk factor for violent injury questionnaire to assess: exposure to chronic violence, criminal justice involvement, substance abuse, and disrespect (code of the street).
We found that 58% of the sample is characterized as trauma recidivists (defined as hospitalization two or more times for violent injury). Black male patients of violent injury who engage in the following: substance abuse; had previously been in a fight or used a weapon in the past year; perceived disrespect as a precursor to violence; and experienced a previous incarceration were more likely to have multiple hospitalizations for violent injury.
Trauma recidivism among urban black male victims of violent injury is a major public health issue. Hospital-based violence intervention programs should be engaged in reducing trauma recidivism among this population.
The prevalence of alcohol-related trauma recidivism: A systematic review
2016, Injury
Citation Excerpt :
Studies were published between 1989 and 2014, with six performed in the USA [1,5,19,20,22,23], four in Europe [13,21,24,25], one in Canada [2], and one in Australia [18]. Most studies were performed at a single centre [1,5,13,18–24], one study involved two major adult trauma referral centres [2], and one was a statewide longitudinal population-based study [25]. With respect to study design, seven studies [2,5,18,19,22,23,25] were retrospective in design, and five studies [1,13,20,21,24] were prospective.
Recurrent admission to a hospital or trauma centre for separate incidents of traumatic injury is known as trauma recidivism. Although use of alcohol is a known risk factor for injury and associated with trauma recidivism, the scale of alcohol-related trauma recidivism has not been well described. The purpose of this review was to search the published literature for studies that evaluated the prevalence of alcohol use among trauma recidivists. Our primary objective was to determine the proportion of trauma recidivism related to alcohol use. The association between alcohol and trauma recidivism was evaluated as a secondary objective.
Four electronic databases (MEDLINE, Embase, CINAHL, Web of Science) were searched from inception until December 2015 for all articles that might provide evidence on the proportion of trauma recidivism related to use of alcohol. After removal of duplicates, the search strategy yielded 2470 records for screening. Only primary studies that reported on repeated admissions to a hospital or trauma centre for traumatic injuries specifically related to alcohol use were included. Descriptive statistics were used to assess study characteristics and the prevalence of trauma recidivism related to alcohol use. An aggregate weighted estimate of alcohol-related trauma recidivism was calculated.
A total of 12 studies met all inclusion criteria. Studies were published between 1989 and 2014. Overall, there were 3386 trauma recidivists among included studies. The proportion of trauma recidivists with evidence of alcohol use on admission ranged from 26.7% to 76.9% (median 46.4%). The aggregated sample produced a weighted estimate of 41.0% (1388/3386) for alcohol-related trauma recidivism. In four studies, the association between alcohol and trauma recidivism was examined; all four found a positive association between alcohol use and repeated admission for traumatic injury. Studies varied considerably in design, trauma populations, periods for evaluating recidivism, definitions for positive alcohol on admission, and methods used to determine alcohol use.
Evidence from current literature suggests that 41.0% of trauma recidivism is related to use of alcohol. Due to methodological limitations among the studies included for review, this may underestimate the actual prevalence of alcohol-related trauma recidivism.
Hospital-centered violence intervention programs: A cost-effectiveness analysis
2015, American Journal of Surgery
Hospital-centered violence intervention programs (HVIPs) reduce violent injury recidivism. However, dedicated cost analyses of such programs have not yet been published. We hypothesized that the HVIP at our urban trauma center is a cost-effective means for reducing violent injury recidivism.
We conducted a cost-utility analysis using a state-transition (Markov) decision model, comparing participation in our HVIP with standard risk reduction for patients injured because of firearm violence. Model inputs were derived from our trauma registry and published literature.
The 1-year recidivism rate for participants in our HVIP was 2.5%, compared with 4% for those receiving standard risk reduction resources. Total per-person costs of each violence prevention arm were similar: $3,574 for our HVIP and $3,515 for standard referrals. The incremental cost effectiveness ratio for our HVIP was $2,941.
Our HVIP is a cost-effective means of preventing recurrent episodes of violent injury in patients hurt by firearms.

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^☆: Supported by a grant from the Emergency Nurses Association and Sigma Theta Tau, Alpha Beta Chapter.

^☆☆: For reprints, write: Vicki Keough, PhD, RN-Cs, ACNP, Loyola University–Chicago School of Nursing, 2160 S First Ave, Building 105, Maywood, IL 60153; E-mail: [email protected] .

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ResearchCharacteristics of the trauma recidivist: An exploratory descriptive study☆,☆☆

Abstract

Section snippets

Method

Findings

Limitations

Discussion

Conclusion

Implication for nurses

Acknowledgements

Arch Surg

Urban trauma: a chronic recurrent disease

J Trauma

The incidence of recurrent penetrating trauma in an urban trauma center

J Trauma

Characteristics of blunt and personal violence injuries

J Trauma

Trauma is a recurrent disease

Surgery

Trauma recidivism

Am Surg

Characteristics of repeat trauma patients, San Diego County

Am J Public Health

Repeat victims of violence in an urban trauma center

Violence Vict

Research
Characteristics of the trauma recidivist: An exploratory descriptive study☆,☆☆