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Factors associated with trauma recidivism in young children
Caroline Q Stephens1, Caroline G Melhado, Amy M Shui
1From the Division of Pediatric Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), UCSF Benioff Children's Hospitals; Department of Surgery (C.Q.S., C.G.M., A.Y., W.M., A.R.J., C.N.), and Department of Epidemiology and Biostatistics (A.M.S.), University of California, San Francisco, San Francisco, California.
Insights
Young children experiencing trauma are at risk for repeat injuries. Medical issues, young age, falls, and injury location are key factors in trauma recidivism for children under 10.
Area of Science:
- Pediatric Trauma Research
- Injury Epidemiology
- Public Health
Background:
- Trauma recidivism is linked to increased morbidity and mortality.
- Socioeconomic factors predict recidivism in older children (10-18 years).
- Risk factors for trauma recidivism in younger children (≤10 years) remain understudied.
Purpose of the Study:
- To identify factors associated with trauma recidivism in children aged 10 years and younger.
- To inform targeted injury prevention strategies for young trauma patients.
Main Methods:
- Retrospective cohort study of pediatric trauma patients (≤10 years) from July 2017 to June 2021.
- Data collected on index injury characteristics, prior injury history, and geocoded Social Vulnerability Index.
- Logistic regression and best subset selection used to identify predictors of recidivism (p < 0.05).
Main Results:
- 4.8% of 3,518 pediatric trauma patients experienced prior injury.
- Recidivism associated with comorbidities, young age, falls, injury location, nontransfer status, and racialization.
- No significant association found between recidivism and Social Vulnerability Index or insurance status.
Conclusions:
- Medical comorbidities, young age, injury location, and falls are primary factors in pediatric trauma recidivism.
- Targeted injury prevention programs supporting parents of young children and those with special healthcare needs are recommended.
- Findings highlight the need for focused interventions to reduce repeat trauma in vulnerable young populations.
Background:
Trauma recidivism is associated with future trauma-associated morbidity and mortality. Previous evidence suggests that socioeconomic factors predict trauma recidivism in older children (10-18 years); however, risk factors in US children 10 years and younger have not been studied. We sought to determine the factors associated with trauma recidivism in young children 10 years and younger.
Methods:
We conducted a retrospective cohort study of pediatric trauma patients 10 years and younger who presented to a single American College of Surgeons-verified Level I pediatric trauma center from July 1, 2017, to June 30, 2021. All patients were evaluated for prior injury during trauma registry entry. Characteristics at the index injury were collected via chart review. Patients were geocoded to assess Social Vulnerability Index. Logistic regression examined factors associated with recidivism. Best subset selection was used to compare multivariable models and identify the most predictive and parsimonious model. Statistical significance was set at p < 0.05.
Results:
Of the 3,518 patients who presented in the study period, 169 (4.8%) experienced a prior injury. Seventy-six percent (n = 128) had one prior injury presentation, 18% (n = 31) had two prior presentations, and 5.9% (n = 10) had three or more. Falls were the most common mechanism in recidivists (63% vs. 52%, p = 0.009). Child physical abuse occurred in 6.5% of patients, and 0.9% experienced penetrating injury. The majority (n = 137 [83%]) were discharged home from the emergency department. There was no significant difference in the frequency of penetrating injury and child physical abuse between recidivists and nonrecidivists. Following logistic regression, the most parsimonious model demonstrated that recidivism was associated with comorbidities, age, falls, injury location, nontransfer, and racialization. No significant associations were found with Social Vulnerability Index and insurance status.
Conclusion:
Medical comorbidities, young age, injury location, and falls were primarily associated with trauma recidivism. Support for parents of young children and those with special health care needs through injury prevention programs could reduce trauma recidivism in this population.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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