Trauma recidivism in England & Wales: Fall after fall after fall

Introduction

Trauma recidivism refers to patients who are injured repeatedly. There has been no nationwide evaluation of trauma recidivism in the United Kingdom (UK). We hypothesise that, because population demographics and trauma mechanisms differ from other studied populations, recidivism would also differ.

Objectives

To describe patient factors, injury characteristics, and outcomes of patients who are injured repeatedly in England & Wales.

Materials & Methods

This was a national, retrospective, population-based cohort study of patients in the Trauma Audit & Research Network's trauma registry for England & Wales in 2019-2021. We defined recidivism as a second admission, with different injuries, within the same 365-day period. The analysis was descriptive.

Results

There were 2517 patients admitted at least twice within 365 days, comprising 5136 total admissions. Median age at first admission was 81 years (IQR 65-88), and 75% were 65 years or older at the time of the index admission; 52% were female. The most common mechanism of injury (MOI) at first admission was fall less than 2 metres (<2m); 86%) and on subsequent admission was also fall<2m (89%; Figure 1). Of the patients whose first admission was caused by a fall<2m, 81% were subsequently injured by the same mechanism. The number of patients with an injury severity score >15 increased from 838 (33%) at first admission to 982 (39%) at second admission. Patients discharged home decreased from 1776 (71%) at first admission to 1449 (58%) at second admission.

Conclusions

Trauma recidivism in the UK primarily relates to elderly patients who suffer repeated low-energy falls. Injury recidivism was uncommon in younger people and was rare following assault/penetrating injury compared to other parts of the world. Subsequent injuries tend to be more severe with fewer patients discharged home. More widespread use of evidence-based prevention strategies should be considered.

Figure 1. MOI for 1st & 2nd admission

No