Urban versus rural trauma recidivism: is there a difference?

Area of Science:

• Trauma Surgery
• Public Health
• Epidemiology

Background:

• Trauma recidivism presents a significant challenge to healthcare systems.
• Understanding the demographic and injury-related characteristics of trauma recidivists is crucial for developing targeted prevention strategies.
• Previous research has not fully elucidated the differences in recidivism patterns between urban and rural populations.

Purpose of the Study:

• To investigate the differences in injury mechanisms and patient characteristics between urban and rural trauma recidivists.
• To test the hypothesis that violent injuries and falls are more prevalent in urban and rural recidivists, respectively.
• To identify factors associated with trauma recidivism in different environments.

Main Methods:

• A retrospective analysis of trauma admissions from 2000 to 2011 was conducted.
• Data on patient demographics, Injury Severity Score (ISS), mortality, and injury cause (fall, violence, other) were collected.
• Univariate analyses and binary logistic regression were used to compare urban and rural recidivists, with stratification by environment.

Main Results:

• Out of 19,600 trauma admissions, 8.6% were attributed to recidivists.
• Urban patients had a higher overall percentage of recidivist trauma admissions (8.6%) compared to rural patients (6.9%).
• After adjusting for age (≥65 years) and injury mechanism, urban patients had 1.12 times higher odds of being a recidivist (OR 1.12; 95% CI 1.01-1.25).
• Falls and violent injuries were significant in both urban and rural recidivist admissions, while age ≥65 years was significant only in rural recidivists.

Conclusions:

• Urban trauma admissions are associated with a 12% higher likelihood of being attributed to a recidivist compared to rural admissions, considering age and mechanism of injury.
• Age ≥65 years is a significant factor for rural recidivism but not urban recidivism.
• Characterizing trauma recidivists by environment and injury patterns can inform the development of targeted interventions to reduce repeat hospitalizations.