Trauma Recidivism Predicts Long-term Mortality: Missed Opportunities for Prevention (Retrospective Cohort Study).
Trauma Recidivism Predicts Long-term Mortality: Missed Opportunities for Prevention (Retrospective Cohort Study).
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DOI：
10.1097/sla.0000000000001823
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发表时间：
2017-05
影响因子：
9
通讯作者：
Smith GS
中科院分区：
文献类型：
--
作者：
Strong BL;Greene CR;Smith GS
本研究的目的是确定复发性创伤入院（累犯）和随后的长期死亡率之间的关系，并确定那些最需要预防干预。单一故意损伤患者的未来损伤死亡风险高于非故意损伤患者，据报告，复发性穿透性创伤的5年死亡率高达20%。创伤复发是一个高危人群，但其与长期死亡率的关系在很大程度上是未知的。从1997年到2008年，识别了一个或多个以前在城市创伤中心住院的患者（累犯），并将其与单次住院的患者（非累犯）进行比较。创伤登记处与国家死亡指数相关联，以确定出院后的死亡原因和死亡时间。统计分析包括卡方检验、Kaplan-Meier生存曲线和考克斯比例风险模型。从1997年到2008年，创伤复发者占总创伤人口的7%，代表3147名患者。与非累犯相比，累犯更可能是男性（P < 0.0001）、黑人（P < 0.0001）、血液酒精含量高于80 mg/dL（P < 0.0001）和遭受穿透伤（P < 0.0001）。初次钝伤和穿透伤的累犯出院后的长期死亡率较高。根据考克斯比例风险比[风险比（HR）1.77，95%置信区间（CI）1.57-2.01]、伤害死亡（HR 2.02，95% CI 1.66-2.47）和疾病死亡（HR 1.65，95% CI 1.41-1.92），累犯比非累犯更可能死于任何原因。男性、黑人、血液酒精含量升高和穿透伤与创伤复发相关，导致死亡风险较高。有一个关键的公共卫生需要制定干预措施，以减少创伤复发和可预防的死亡。
The objectives of this study were to determine the association between recurrent trauma admissions (recidivism) and subsequent long-term mortality, and to identify those in most need for preventive interventions. Patients with a single intentional injury have been shown to have a higher risk of future injury mortality than those with unintentional injury with 5-year mortality rates as high as 20% being reported for recurrent penetrating trauma. Trauma recidivism identifies a high-risk population, but its association with long-term mortality is largely unknown. Patients with 1 or more previous admissions to an urban trauma center (recidivists) were identified and compared with those with single admissions (nonrecidivists) from 1997 to 2008. The trauma registry was linked to the National Death Index to determine both the cause and time to death after hospital discharge. Statistical analysis included chi-square tests, Kaplan-Meier survival curves, and Cox proportional-hazards models. Trauma recidivists were 7% of the total trauma population from 1997 to 2008, representing 3147 patients. Recidivists were more likely to be male (P < 0.0001), Black (P < 0.0001), have a blood alcohol content above 80mg/dL (P < 0.0001), and suffer a penetrating injury (P < 0.0001) compared with nonrecidivists. Recidivists with both initial blunt and penetrating injuries had higher rates of long-term mortality after discharge. Recidivists were more likely to die of any cause based on Cox proportional-hazard ratios [hazard ratio (HR) 1.77, 95% confidence interval (CI) 1.57–2.01], injury death (HR 2.02, 95% CI 1.66–2.47), and disease death (HR 1.65, 95% CI 1.41–1.92) than nonrecidivists. Male sex, Black race, and elevated blood alcohol content and penetrating injury are associated with trauma recidivism which leads to a higher risk of death. There is a critical public health need to develop interventions to reduce trauma recidivism and preventable death.