Trauma recurrence in the pediatric emergency population

Background: A link between ambulatory trauma and trauma recurrence may be h ypothesized: (a) children who present for trauma may be those with characte ristics that place them at particular risk; (b) children who frequently pre sent for trauma may be those who present because of parental anxiety; and ( c) children may learn from traumatic episodes and therefore decrease their trauma risk. Methods: A retrospective chart review of billing data was conducted to dete rmine the value of the emergency department trauma visit count as a predict or of future trauma visits and to validate one of the models described abov e, Results: Records for 16,994 patients were obtained for the period January I through December 31, 1997, and these patients were followed as a cohort th rough the first 6 months of 1998. There were 9,236 males and 7,757 females. Of these, 5,413 patients had a trauma visit count in 1997 (TC97) of at lea st 1; 120 patients had a TC97 of 3 or more. The relationship between TC97 a nd trauma visit count in 1998 was linear, present in both males and females and across all age categories, with odds ratios for the group with TC97 gr eater than or equal to 3 ranging from 3.8 to 6.4, Conversely, the risk of p resentation with respiratory tract infection during the study period in 199 8 was not increased,vith higher TC97 values. Conclusion: Our data support the theory that children who present,vith trau ma tend to be those,vith extrinsic or intrinsic factors that increase traum a risk. We have demonstrated a direct relationship between emergency depart ment visit counts for trauma with future trauma occurrence risk. This relat ionship is present at ail ages and in both males and females. The emergency trauma visit count is an easily obtained measure that has merit as an inde x to identify higher-risk children for possible intervention strategies. Fu rther work is needed.