Prior Emergency Department Utilization as a Predictor for Severe Penetrating Trauma: A Retrospective Cohort Study Open Access

Reitz, Alexandra Clarice Weber (2017)

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Homicide and suicide are leading causes of mortality among adults under the age of 65. While extensive research has been conducted on healthcare utilization subsequent to severe penetrating trauma events, there is a dearth of information on healthcare utilization prior to these events. This study examined emergency department (ED) utilization patterns to determine if prior ED visits for injury were a risk factor for severe penetrating trauma.


This retrospective cohort study examined the ED visit records of 215,800 patients with 489,800 ED visits and 3,322 trauma registry patients from November 2010 to February 2015 at a large, urban hospital with a Level I trauma center. Data analysis was conducted using logistic regression and Cox proportional hazard models.


Among 215,800 ED patients, 224 patients with prior ED visits experienced severe penetrating trauma, accounting for 7% of all penetrating trauma registry patients. In a bivariate model, prior ED visits for injury (Odds Ratio (OR) 2.17, Confidence Interval (CI) 1.67 to 2.83, p< 0.0001) were significantly associated with severe penetrating trauma. After adjustment for age, gender, employment, insurance, high utilization, and admission status, prior ED visits for injury continued to be associated with severe penetrating trauma (OR 1.60, CI 1.21 to 2.10, p=0.001). Cox proportional hazard models were used to estimate hazard ratios (HR) for factors associated with time to a penetrating trauma event following a patient's last ED visit. After adjusting for age, gender, employment status, admission status, high utilization, and insurance status, patients with an injury diagnosis at their last ED visit had a HR of 1.43 (CI 1.07-1.93, p=0.016).


After adjusting for confounders, a previous ED visit for injury remained a significant risk factor for severe penetrating trauma. Patients with a last ED visit for injury also had an elevated rate of time to penetrating trauma. These findings suggest a need for targeted violence intervention programs and improved ED injury surveillance.

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