A link between ambulatory trauma and trauma recurrence may be hypothesized: (a) children who present for trauma may be those with characteristics that place them at particular risk; (b) children who frequently present 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.
A retrospective chart review of billing data was conducted to determine the value of the emergency department trauma visit count as a predictor of future trauma visits and to validate one of the models described above.
Records for 16,994 patients were obtained for the period January 1 through December 31, 1997, and these patients were followed as a cohort through 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 least 1; 120 patients had a TC97 of 3 or more. The relationship between TC97 and 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 > or =3 ranging from 3.8 to 6.4. Conversely, the risk of presentation with respiratory tract infection during the study period in 1998 was not increased with higher TC97 values.
Our data support the theory that children who present with trauma tend to be those with extrinsic or intrinsic factors that increase trauma risk. We have demonstrated a direct relationship between emergency department visit counts for trauma with future trauma occurrence risk. This relationship is present at all ages and in both males and females. The emergency trauma visit count is an easily obtained measure that has merit as an index to identify higher-risk children for possible intervention strategies. Further work is needed.