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Trauma recurrence in the pediatric emergency population
B W Taylor1, J MacIntyre, P Forgeron
1Emergency Department, Isaac Walton Killam Grace Health Centre for Women, Children and Families, Halifax, Nova Scotia, Canada. btaylor@ccmail.iwkgrace.ns.ca
Insights
Children with higher emergency department trauma visit counts are at increased risk for future trauma. This finding helps identify at-risk children for early intervention, improving pediatric trauma care.
Area of Science:
- Pediatric emergency medicine
- Trauma research
- Public health
Background:
- Hypothesized link between ambulatory trauma and trauma recurrence in children.
- Children presenting for trauma may have inherent risk factors or be influenced by parental anxiety.
- Learning from traumatic episodes may influence future trauma risk.
Purpose of the Study:
- To determine if emergency department trauma visit count predicts future trauma visits.
- To validate models linking trauma visit history to recurrence risk.
- To assess the utility of trauma visit counts as an index for identifying high-risk children.
Main Methods:
- Retrospective chart review of billing data from 16,994 patients (1997-1998).
- Analysis of trauma visit count in 1997 (TC97) as a predictor of trauma visits in 1998.
- Examined relationship across age categories and genders.
Main Results:
- A linear relationship was found between TC97 and future trauma visits (OR 3.8-6.4 for TC97 ≥3).
- This association was consistent across all ages and genders.
- No increased risk for respiratory tract infections was associated with higher TC97.
Conclusions:
- Data support the theory that children with trauma have underlying risk factors.
- Emergency department trauma visit count is a direct predictor of future trauma risk.
- Trauma visit count is a valuable, easily obtained index for identifying children needing intervention.
Background:
A link between ambulatory trauma and trauma recurrence may be hypothesized: (a) children who present for trauma may be those with characteristics that place them at particular risk; (b) children who frequently present for trauma may be those who present because of parental anxiety; and (c) children may learn from traumatic episodes and therefore decrease their trauma risk.
Methods:
A retrospective chart review of billing data was conducted to determine the value of the emergency department trauma visit count as a predictor of future trauma visits and to validate one of the models described above.
Results:
Records for 16,994 patients were obtained for the period January 1 through December 31, 1997, and these patients were followed as a cohort through the first 6 months of 1998. There were 9,236 males and 7,757 females. Of these, 5,413 patients had a trauma visit count in 1997 (TC97) of at least 1; 120 patients had a TC97 of 3 or more. The relationship between TC97 and trauma visit count in 1998 was linear, present in both males and females and across all age categories, with odds ratios for the group with TC97 > or =3 ranging from 3.8 to 6.4. Conversely, the risk of presentation with respiratory tract infection during the study period in 1998 was not increased with higher TC97 values.
Conclusion:
Our data support the theory that children who present with trauma tend to be those with extrinsic or intrinsic factors that increase trauma risk. We have demonstrated a direct relationship between emergency department visit counts for trauma with future trauma occurrence risk. This relationship is present at all ages and in both males and females. The emergency trauma visit count is an easily obtained measure that has merit as an index to identify higher-risk children for possible intervention strategies. Further work is needed.