Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC)

Matthew D Price; Katherine M McDermott; Daniel An; Usman Aslam; Mark B Slidell; Isam W Nasr

doi:10.1016/j.jpedsurg.2024.04.002

Pediatric Trauma Recidivism: A Statewide Risk Factor Analysis of the Maryland Health Services Cost Review Commission (HSCRC)

J Pediatr Surg. 2024 Apr 9:S0022-3468(24)00249-5. doi: 10.1016/j.jpedsurg.2024.04.002. Online ahead of print.

Authors

Matthew D Price¹, Katherine M McDermott², Daniel An³, Usman Aslam⁴, Mark B Slidell⁵, Isam W Nasr⁵

Affiliations

¹ Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: matthew.dean.price@gmail.com.
² Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Division of Trauma and Acute Care Surgery, Honorhealth John C. Lincoln Medical Center, Phoenix, AZ, USA.
⁵ Division of Pediatric Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

PMID: 38705831
DOI: 10.1016/j.jpedsurg.2024.04.002

Abstract

Background: National estimates suggest pediatric trauma recidivism is uncommon but are limited by short follow up and narrow ascertainment. We aimed to quantify the long-term frequency of trauma recidivism in a statewide pediatric population and identify risk factors for re-injury.

Methods: The Maryland Health Services Cost Review Commission Dataset was queried for 0-19-year-old patients with emergency department or inpatient encounters for traumatic injuries between 2013 and 2019. We measured trauma recidivism by identifying patients with any subsequent presentation for a new traumatic injury. Univariate and multivariable regressions were used to estimate associations of patient and injury characteristics with any recidivism and inpatient recidivism.

Results: Of 574,472 patients with at least one injury encounter, 29.6% experienced trauma recidivism. Age ≤2 years, public insurance, and self-inflicted injuries were associated with recidivism regardless of index treatment setting. Of those with index emergency department presentations 0.06% represented with an injury requiring inpatient admission; unique risk factors for ED-to-inpatient recidivism were age >10 years (aOR 1.61), cyclist (aOR 1.31) or burn (aOR 1.39) mechanisms, child abuse (aOR 1.27), and assault (aOR 1.43). Among patients with at least one inpatient encounter, 6.3% experienced another inpatient trauma admission, 3.4% of which were fatal. Unique risk factors for inpatient-to-inpatient recidivism were firearm (aOR 2.48) and motor vehicle/transportation (aOR 1.62) mechanisms of injury (all p < 0.05).

Conclusions: Pediatric trauma recidivism is more common and morbid than previously estimated, and risk factors for repeat injury differ by treatment setting. Demographic and injury characteristics may help develop and target setting-specific interventions.

Level of evidence: III (Retrospective Comparative Study).

Keywords: Area deprivation index; Injury recidivism; Pediatric injury; Pediatric trauma; Trauma recidivism.

Grants and funding

T32 HL007024/HL/NHLBI NIH HHS/United States