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September 19, 2016

Penn study: 1 in 9 who enter ER with violent injuries return within two years

Comprehensive analysis finds greatest risk factors, incredible costs

Victims of intentional violence are at relatively high risk of returning to the Emergency Room within two years of an initial visit, according to a study conducted by the Perelman School of Medicine at the University of Pennsylvania. 

The 2010 analysis at Florida ERs found that one out of every nine patients who entered the hospital for intentional gunshot, stabbing and assault wounds were subject to recurrent violent injury. Among the most prevalent risk factors, homelessness and residence in low-income neighborhoods produced the highest number of repeat visits, followed by psychiatric emergencies and alcohol abuse.

“As physicians, when we take care of injured people in the emergency room, we have a critical opportunity to assess their health and safety, and to prevent future injuries,” said lead author Elinore Kaufman, MD, who conducted the study while earning a Master of Science in Health Policy at Penn. “While violence prevention programs in trauma centers have been shown to be effective, recurrent violent injury is still very common and very costly. We need to be doing more to make sure every patient has the resources they need to stay safe.”

Regarded as the most comprehensive study to date on recurrent violent injury, Kaufman's team found that there were nearly 70,000 combined initial and recurring injuries between 2010-2012, generating almost $600 million in medical charges. Among 53,908 patients who visited the ER in 2010 for violent injuries not deemed intentional, 11 percent returned for another injury within two years. Another 20 percent of that group had two or more visits, many of them classified as severe.

Several other findings emerged from the study as well:

• Patients using Medicaid or who were uninsured had recurrent injuries at about twice the rate of other patients.

• Homeless patients were 60 percent more likely to experience recurrent injuries, compared to non-homeless.

• African Americans also made up a disproportionately high percentage of initial injury victims and were 10 percent more likely to have a recurrent injury compared to whites, and 40 percent more likely to have a severe recurrent injury.

• Female victims were as likely as men to have recurring injuries, but were 70 percent less likely to have a recurrent severe injury.

About one-third of all violently injured patients were sent to a specialized trauma center, while the rest were treated at community non-trauma center ERs. More than half who returned for a recurring injury were treated at a hospital other than the one they visited for the initial violent injury.

“These findings can serve as a baseline for interventions aimed at reducing recurrence,” said senior author Dr. M. Kit Delgado, an assistant professor of Emergency Medicine and Biostatistics & Epidemiology at Penn Medicine, which collaborated with the University of Florida College of Medicine. 

“Our findings also highlight the potential for housing stability, behavioral health and substance abuse programs to break cycles of violence," Delgado added. 

Nationwide, the CDC estimates that interpersonal violence led to 16,671 deaths, 140,343 hospitalizations, and 1,615,995 ER visits in 2010. The $8.5 billion in associated medical costs was higher than the nominal GDP of multiple countries around the world.

[The American Journal of Emergency Medicine]

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