Among children who survive traumatic injuries in the US, nearly 3% experience another sudden injury the same year. Of these repeated injuries, about 1 in 5 cases are caused by violence, according to a recent study. Some of these patients have a 42% tendency for drug use and a two-fold increased likelihood of depression or psychosis, as opposed to patients without trauma, shows analysis.
"This rate of repeated injury among children is too high. Once a child has a major trauma, he or she shouldn't be coming back again to the hospital with similar types of injuries", says senior investigator Mikael Petrosyan, a pediatric surgeon at Children's National Medical Center in Washington, DC.
Dr. Petrosyan says, "This study opens up an opportunity to look further at this problem of why there is a high incidence of recidivism (new and recurrent injuries) after major trauma in children."
The study's lead investigator and a surgical resident at Howard University Hospital, Adil A Shah, hopes that this study will be a starting point for identifying children at risk of trauma recidivism so that healthcare providers can intervene early after the initial exposure to traumatic stimuli.
While trauma in children is known - 9.2 million children and teens up to age 19 receive treatment for non-fatal injuries in emergency rooms and more than 12,000 die every year (according to the Centers for Disease Control and Prevention) - the proportion of children who come back to the hospital with a different traumatic injury has not been reported earlier.
Accordingly, in this study, the researchers mined patient readmission information from a database containing hospital discharge records from 27 states. After analyzing 286,508 records of pediatric major trauma cases from 2010 to 2015, they studied the risk factors and costs of sustaining more than one major injury in a year.
They found that 8,309 children aged 18 years and younger were readmitted with another severe or moderately severe injury that same year. Of those patients, 16 percent - more than 1,300 children and teenagers - had three or more trauma-related hospital admissions in a year, according to the study.
The analysis also reveals that some of the injuries were intentional: 10% are reportedly due to self-injury and 9% due to assault. When the team compared this data with patients without trauma, they observed that 22% are as likely to come from lower-income families and 30 percent were as likely to have public health insurance such as Medicaid.
By studying their behavior after the first admission, the team found that as compared to non-trauma patients, 42% of these children are more likely to consume drugs and have an increased likelihood of depression or psychosis.
The research team saw one trend that stuck out: 80% of them had a higher likelihood of leaving the hospital during their initial injury, even after they were advised against doing so. This could be due to financial constraints as they most likely belonged to a low-income group, says Dr. Shah.
Despite this, the team found that there is a huge burden on the US health care expenditure. The researchers think that patients' access to insurance could be the driving force behind it. Readmissions for these children cost $8,386, which is more than the first hospital stay, with an estimated excess cost of $1.2 million per year, says the study.
The experts highlight one limitation in their study. As the database only contains information on patient readmissions in one year, the team could not study records of injured patients who were readmitted in a different year. Hence, the study most likely underestimates the true rate of such recurrences in pediatric major trauma cases, they add.
To contain the rise of recurrent cases of trauma, the experts suggest making appropriate referrals for follow-up care in cases of injuries associated with mental illness or drug abuse. They add that increased efforts to prevent childhood injury and violence can help as well.