Cumulative traumatic life events and increased risk for emergency department and inpatient utilization after physical injury hospitalization.

introductionFew large-scale investigations have examined the association between the cumulative burden of traumatic life events and population-based assessments of emergency department (ED) and inpatient utilization among physically injured trauma survivors.

methodsThe investigation was a secondary analysis of a randomized clinical trial that examined the association between cumulative traumatic life events and ED/inpatient utilization after physical injury hospitalization. All 445 physically injured trauma survivors included in the investigation were aged ≥ 18 and underwent screening for elevated posttraumatic stress symptoms. Three types of patient characteristics were examined for potential significant associations with the longitudinal ED/inpatient utilization outcome: pre-injury, baseline at the time of index physical injury admission, and events that occurred in the year post-injury. Regression analyses were used to assess the association between these clinical and demographic characteristics and ED/inpatient utilization in the 12-36 months after the index injury admission.

resultsApproximately one-third of patients reported ≥ 7 serious traumatic life events before the index injury admission. Approximately 62% of patients had one or more ED/inpatient visits over the course of the 12-36 months post-injury. Clinical and demographic characteristics that were significantly associated with ED/inpatient visits were ≥ 7 prior traumas (Odds Ratio [OR] = 1.35, 95% Confidence Interval [CI] = 1.02, 1.78), pre-injury ED visits (OR = 2.42, CI = 1.85, 3.15), lower educational attainment (OR = 1.41, CI = 1.08, 1.86), and traumatic life events in the year following injury admission (OR = 2.53, CI = 1.72, 3.73).

conclusionIn a cohort of hospitalized physically injured trauma survivors, both pre-injury and post-injury traumatic life events were associated with an increased risk of ED/inpatient utilization. Pre- and post-injury traumatic life events retained their association with increased utilization even after adjusting for relevant clinical and demographic characteristics. Future investigations examining health service use after traumatic injury could be conducted in more generalizable samples of injury survivors and also could productively incorporate assessments of cumulative lifetime trauma burden. Such research could further explore the relationships between lifetime trauma history, post-traumatic stress symptoms, functional impairments, and health service utilization in order to develop effective interventions for diverse trauma survivors.