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A Different Disease

Eric A. Toschlog, MD; Scott G. Sagraves, MD; Michael R. Bard, MD; Paul J. Schenarts, MD; Claudia C. Goettler, MD; Mark A. Newell, MD; Michael F. Rotondo, MD

Arch Surg. 2007;142(1):77-81.

Hypothesis  Unlike the well-characterized urban trauma recidivist (RC), factors associated with the rural RC remain undefined. In an attempt to devise preventative strategies, we theorized that the rural RC profile would be similar to that of urban counterparts.

Design  Retrospective review.

Setting  Rural, university-affiliated, level I trauma center.

Patients  All trauma patients admitted between January 1, 1994, and December 30, 2002.

Interventions  Identification and characterization of rural trauma RCs.

Main Outcome Measures  Trauma recidivism incidence, risk factors, and cost.

Results  Of 15 370 consecutive admissions, 528 (3.4%) were RCs. Demographic comparisons to a non-RC cohort demonstrated rural RCs to be significantly older (mean ± SD age, 55.9 ± 24.8 vs 39.7 ± 24.1 years), disproportionately white (65.2% [344/528] vs 56.5% [8386/14 842]), and more likely female (49.1% [259/528] vs 37.3% [5537/14 842]) (P<.001 for all). Clinical comparisons revealed significant associations between recidivism and substance abuse. The percentage of positive blood ethanol screen results (58.7% [310/528] vs 39.9% [5923/14 842]) and the mean ± SD blood ethanol content (132.1 ± 139.9 mg/dL [28.7 ± 30.4 mmol/L] vs 69.5 ± 114.4 mg/dL [15.1 ± 24.8 mmol/L]) were higher for RCs (P<.001 for both). In addition, cocaine use was significantly higher in the RC cohort (6.4% [34/528] vs 4.1% [607/14 842]; P=.02). The total cost for all RC admissions exceeded $7 million.

Conclusions  The rural RC profile is strikingly different from urban counterparts. The common feature seems to be substance abuse. Correspondingly, prevention strategies for recidivism must be considerably different among rural and urban populations.

Author Affiliations: Department of Surgery, The Brody School of Medicine at East Carolina University, and Center of Excellence for Trauma and Surgical Critical Care, University Health Systems of Eastern North Carolina, Greenville.

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