TY - JOUR
T1 - Rural trauma recidivism
T2 - A different disease
AU - Toschlog, Eric A.
AU - Sagraves, Scott G.
AU - Bard, Michael R.
AU - Schenarts, Paul J.
AU - Goettler, Claudia C.
AU - Newell, Mark A.
AU - Rotondo, Michael F.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2007
Y1 - 2007
N2 - Hypothesis: Unlike the well-characterized urban trauma recidivist (RC), factors associated with the rural RC remain undefined. In an attempt to devise preventative strategies, we theorized that the rural RC profile would be similar to that of urban counterparts. Design: Retrospective review. Setting: Rural, university-affiliated, level I trauma center. Patients: All trauma patients admitted between January 1, 1994, and December 30, 2002. Interventions: Identification and characterization of rural trauma RCs. Main Outcome Measures: Trauma recidivism incidence, risk factors, and cost. Results: Of 15 370 consecutive admissions, 528 (3.4%) were RCs. Demographic comparisons to a non-RC cohort demonstrated rural RCs to be significantly older (mean±SD age, 55.9±24.8 vs 39.7±24.1 years), disproportionately white (65.2% [344/528] vs 56.5% [8386/14 842]), and more likely female (49.1% [259/528] vs 37.3% [5537/14 842]) (P<.001 for all). Clinical comparisons revealed significant associations between recidivism and substance abuse. The percentage of positive blood ethanol screen results (58.7% [310/528] vs 39.9% [5923/14 842]) and the mean±SD blood ethanol content (132.1±139.9 mg/dL [28.7±30.4 mmol/L] vs 69.5±114.4 mg/dL [15.1±24.8 mmol/L]) were higher for RCs (P<.001 for both). In addition, cocaine use was significantly higher in the RC cohort (6.4% [34/528] vs 4.1% [607/14 842]; P=.02). The total cost for all RC admissions exceeded $7 million. Conclusions: The rural RC profile is strikingly different from urban counterparts. The common feature seems to be substance abuse. Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations.
AB - Hypothesis: Unlike the well-characterized urban trauma recidivist (RC), factors associated with the rural RC remain undefined. In an attempt to devise preventative strategies, we theorized that the rural RC profile would be similar to that of urban counterparts. Design: Retrospective review. Setting: Rural, university-affiliated, level I trauma center. Patients: All trauma patients admitted between January 1, 1994, and December 30, 2002. Interventions: Identification and characterization of rural trauma RCs. Main Outcome Measures: Trauma recidivism incidence, risk factors, and cost. Results: Of 15 370 consecutive admissions, 528 (3.4%) were RCs. Demographic comparisons to a non-RC cohort demonstrated rural RCs to be significantly older (mean±SD age, 55.9±24.8 vs 39.7±24.1 years), disproportionately white (65.2% [344/528] vs 56.5% [8386/14 842]), and more likely female (49.1% [259/528] vs 37.3% [5537/14 842]) (P<.001 for all). Clinical comparisons revealed significant associations between recidivism and substance abuse. The percentage of positive blood ethanol screen results (58.7% [310/528] vs 39.9% [5923/14 842]) and the mean±SD blood ethanol content (132.1±139.9 mg/dL [28.7±30.4 mmol/L] vs 69.5±114.4 mg/dL [15.1±24.8 mmol/L]) were higher for RCs (P<.001 for both). In addition, cocaine use was significantly higher in the RC cohort (6.4% [34/528] vs 4.1% [607/14 842]; P=.02). The total cost for all RC admissions exceeded $7 million. Conclusions: The rural RC profile is strikingly different from urban counterparts. The common feature seems to be substance abuse. Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations.
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U2 - 10.1001/archsurg.142.1.77
DO - 10.1001/archsurg.142.1.77
M3 - Article
C2 - 17224504
AN - SCOPUS:33846225605
SN - 0004-0010
VL - 142
SP - 77
EP - 81
JO - Archives of Surgery
JF - Archives of Surgery
IS - 1
ER -