Trauma recidivism: epidemiology and predictors in a level I trauma center

BACKGROUND: Trauma is the leading cause of death for individuals under age 45 and disproportionately affects underserved populations. Trauma recidivism is defined as recurrent hospital admissions for injury-a substantial burden on healthcare systems. In regions such as Allegheny County, Pennsylvania, which has a large, aging population, recidivism is often influenced by social, behavioral, and structural determinants. This study examines patterns of trauma recidivism at an urban tertiary trauma center and identifies associated risk factors to guide targeted interventions in both hospital and community settings. METHODS: We conducted a retrospective cohort study using a trauma registry at a level I urban trauma center, including 13,967 patients admitted between January 2021 and September 2024. Patients were categorized as recidivists (n = 245) or non-recidivists (n = 13,455) based on repeated trauma admissions due to the same mechanism of injury. Demographic, injury, hospital course, and discharge variables were compared between recidivists and non-recidivists using chi-square tests, t-tests, or nonparametric equivalents as appropriate. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of recidivism. RESULTS: Recidivists accounted for 3.7% of the cohort. Compared to non-recidivists, recidivists were older (mean age 68.5 vs. 55.7 years, p < 0.001) and more likely to be female (53.9% vs. 40.5%, p < 0.001). Falls were the predominant injury mechanism (84.6% vs. 52.6%, p < 0.001), frequently occurring in home (56.4%, p < 0.001), particularly in bedrooms and bathrooms. Recidivists were less often discharged home (42.8% vs. 63.2%, p < 0.001). Risk of recidivism was higher among patients with injuries due to falls and self-harm, older age, female sex, and those discharged against medical advice or to a drug and alcohol rehabilitation facility. CONCLUSIONS: Trauma recidivism is increasingly driven by older adults with blunt injuries, highlighting a shift in the at-risk population. Prevention efforts should adapt to focus on age-related risks such as falls and frailty. Tailored discharge planning, psychosocial support, and post-discharge follow-up care may help reduce recurrent injury and improve outcomes in this growing patient group. LEVEL OF EVIDENCE: Level IV, Prognostic/Epidemiological.