Researchers share findings on trauma recidivism in U.S. children

Among U.S. children who survive major trauma—bodily injuries severe enough to require a hospital stay—nearly 3 percent experience another sudden injury in the same year and nearly one in five of these repeated injuries is the result of violence, according to research presented at Clinical Congress.  

Every year, 9.2 million children and teens up to age 19 receive treatment for nonfatal injuries in emergency rooms, and more than 12,000 die, according to the Centers for Disease Control and Prevention. 

“We know that trauma is the leading cause of death in children,” said Adil A. Shah, MD, the study’s lead investigator and a surgery resident, Howard University Hospital, Washington, DC. “However, among those young patients who survive, the proportion who come back to the hospital with a different traumatic injury and their risk factors were previously unquantified.” 

In the study, Dr. Shah and his colleagues found that 8,309 U.S. children ages 18 years and younger returned to the hospital with another severe or moderately severe injury the same year as their initial trauma, a 2.9 percent recurrence rate. Of those patients, 16 percent—more than 1,300 children and teenagers—had three or more trauma-related hospital admissions in a year.  

The researchers analyzed 286,508 records of pediatric major trauma cases from 2010 through 2015 from the National Readmissions Database, which includes hospital discharge records from 27 states with readmissions in the same calendar year. The investigators then identified admissions that resulted from a different injury than the original. They also studied the risk factors for and costs of sustaining more than one major injury in a year. 

Repeat trauma patients ranged in age from 7 to 17 years old, and the most common site of severe injury was the head and neck, occurring in 11.3 percent of these patients, Dr. Shah reported. Intentional injuries affected 19 percent of repeated trauma patients versus less than 12 percent of the other trauma patients; 10 percent were reportedly the result of self-injury and 9 percent the result of assault.  

Compared with patients in whom trauma did not recur, repeated trauma patients had the following characteristics: 

22 percent as likely to come from lower-income families and 30 percent as likely to have public health insurance, such as Medicaid 

42 percent increased likelihood of drug use and a twofold increased likelihood of having depression or psychosis 

Odds of more than 2:1 of having penetrating injuries—usually gun or stab wounds—at first hospital admission 

Nearly twice the odds of having higher injury severity at their first admission 

80 percent higher likelihood of leaving the hospital against medical advice for their initial injury 

The researchers found that readmission cost $8,386 more than the first hospital stay, with an estimated excess cost of $1.2 million per year in the study population. Although the reasons for the increased cost are unclear, Dr. Shah said that because many of these patients had public insurance, “the burden placed on U.S. health care expenditure is immense.” 

He added that the study likely underestimates the true recurrence rate of pediatric major trauma. The National Readmissions Database does not capture records of injured patients who are readmitted in a different year.  

“This study opens up an opportunity to look further at this problem of why there is a high incidence of recidivism after major trauma in children,” said senior investigator Mikael Petrosyan, MD, FACS, a pediatric surgeon, Children’s National Medical Center, Washington, DC. 

“We hope our findings will be a starting point for identifying children at risk for trauma recidivism, so health care providers can intervene early after the initial exposure to traumatic stimuli,” Dr. Shah added. Interventions could include making appropriate referrals for follow-up care in cases of injuries associated with mental illness or drug abuse, as well as increasing efforts to prevent childhood injury and violence, he suggested.  