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Return Visits for Intentional Violent Injuries Costly, Possibly Predictable

October 3rd, 2016

PHILADELPHIA – After emergency physicians in Florida treat patients for injuries caused by acts of intentional violence, it might be more accurate for them to say, “See you later,” than “Goodbye.”

A study published in the American Journal of Emergency Medicine reports that one in nine of the patients who presented to Florida EDs in 2010 with injuries related to shootings, stabbings, and other assaults ended up with another violent injury within two years.

The study from the Perelman School of Medicine at the University of Pennsylvania is touted as the most comprehensive study to date on recurrent violent injury, its costs, and risk factors.

Researchers found the following risk factors were linked to recurrent violent injury:

  • homelessness;
  • residence in low income neighborhoods; and
  • other ED visits for psychiatric emergencies or alcohol abuse.

Better understanding of the causes of repeat visits for violent injuries is important, according to study authors, because the nearly 70,000 ED visits for initial and recurring injuries included in the study generated almost $600 million in medical charges.

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“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, a resident at New York-Presbyterian/Weill Cornell Medical Center in New York, 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.”

For the study, researchers collaborated with colleagues at the University of Florida College of Medicine to examine ED-reported injuries from interpersonal violence for the entire state of Florida. The investigation included all initial visits during 2010 and any recurrent visits within two years.

Results indicate that, of 53,908 people who visited Florida EDs in 2010 for violent injuries — excluding intentional injuries — 11% returned with a new violent injury at least once within two years. In fact, 20% of them had two or more recurrences, and 336 had recurrent injuries that were classified as severe.

Only about a third of all violently injured patients, and half with severe injuries, were sent to specialized trauma centers, according to the results, with the rest being treated at community non-trauma center EDs. Furthermore, more than half of patients presented at a different hospital for recurrent injuries than where they were treated for their prior injury.

“These findings can serve as a baseline for interventions aimed at reducing recurrence,” said senior author M. Kit Delgado, MD, MS, an assistant professor of Emergency Medicine and Biostatistics and Epidemiology at Penn. “Our findings also highlight the potential for housing stability, behavioral health and substance abuse programs to break cycles of violence."