National Trends and Resource Utilization Associated with Penetrating Trauma Recidivism

BACKGROUNDWhile recurrent penetrating trauma has been associated with long-term mortality and disability, national data on factors associated with reinjury remain limited. We examined temporal trends, patient characteristics, and resource utilization associated with repeat firearm-related or stab injury across the US. METHODSThe 2010-2019 Nationwide Readmissions Database was queried to identify all hospitalizations for penetrating trauma. Recidivism was defined as those returned for subsequent penetrating injury within 60 days. We quantified injury severity using the International Classification of Diseases Trauma Mortality Prediction model. Trends in recidivism, length of stay (LOS), hospitalization costs, and rate of non-home discharge were then analyzed. Multivariable regression models were developed to assess the association of recidivism with outcomes of interest. RESULTSOf an estimated 968,717 patients (28.4% Gunshot, 71.6% Stab), 2.1% experienced recidivism within 60 days of initial injury. From 2010 to 2019, trauma recidivism of gunshot wound increased in annual incidence while that of stab remained stable. Patients experiencing penetrating trauma recidivism were more commonly male, younger and insured by Medicaid. Patients with recidivism had shorter index LOS, lower median index hospitalization cost and higher rates of non-home discharge. After risk adjustment, penetrating trauma recidivism was associated with significantly higher hospitalization costs, shorter time before readmission, and increased odds of non-home discharge. In addition, comorbid conditions of hypothyroidism and psychoses were associated with greater likelihood of stab wound recidivism. CONCLUSIONThe trend in penetrating trauma recidivism has been on the rise for the past decade. National efforts to improve post-discharge prevention and social support services for patients with penetrating trauma are warranted and may reduce the burden of recidivism.