Current Trends Repeat Injuries in an Inner City Population --Philadelphia, 1987-1988

Findings from the Philadelphia Injury Prevention Program (PIPP) indicate that repeat injuries account for 10% of visits to emergency rooms (ERs) for injuries. Because understanding of the epidemiology of repeat injuries is limited, data from PIPP were used to examine this problem. PIPP is a cooperative effort by the Philadelphia Department of Public Health, the University of Pennsylvania School of Medicine, and CDC. PIPP maintains surveillance of virtually all emergency-room (ER)-treated injuries sustained by 68,103 inner city residents living in 17 census tracts in Philadelphia. This report focuses on repeat injuries among this predominantly (97%) black, indigent population (estimated 1987 median household income: $11,810) (Donnelley Marketing Information Services, unpublished data).

An injury was defined as a visit to an ER in Philadelphia for care or evaluation of an injury. A repeat injury was defined as a discrete injury in the same person after an initial injury during a 1-year surveillance period (March 1, 1987, to February 29, 1988). Excluded from this definition were visits to an ER for follow-up care of an injury (e.g., suture removal, cast replacement, or wound redressings).

During the study period, the surveillance system identified 9567 injuries in 8600 persons (12.6% of the study population). Of these, 2161 (22.6%) resulted from falls, 1960 (20.5%) from interpersonal violence, 1500 (15.7%) from motor vehicle-related incidents, 965 (10.1%) from unintentional blunt trauma, and 895 (9.4%) from unintentional cuts. The remaining 2086 injuries (21.8%) resulted from other causes.

Of the 9567 injuries, 967 (10.1%) were repeat injuries to 802 (9.3%) persons. Of the repeat injuries, 268 (27.7%) resulted from interpersonal violence, 193 (20.0%) from falls, 111 (11.5%) from motor vehicle-related incidents, 93 (9.6%) from unintentional blunt trauma, and 82 (8.5%) from unintentional cuts. The remaining 220 (22.8%) resulted from other causes.

Of the 802 persons with repeat injuries, 521 (65.0%) were male. Two hundred eighty-two (35.2%) were 0-19 years of age; 499 (62.2%) were 20-64; and 21 (2.6%) were greater than or equal to 65. Six hundred eighty-three (85.2%) persons were injured twice; 85 (10.6%), three times; 25 (3.1%), four times; six (0.7%), five times; and three (0.4%), six times. Seven persons died from a repeat injury.

The cause of initial injury differed little between persons with repeat injuries and those with one injury (Figure 1). Of the 802 persons with repeat injuries, 224 (27.9%) had two or more injuries from a similar cause. Interpersonal violence was the most common cause of a repeat injury resulting from a similar cause. Of the 184 persons with repeat injuries and at least one injury from interpersonal violence, 88 (47.8%) had at least one additional injury from interpersonal violence and 15 had three or more injuries from interpersonal violence. Of the 172 persons whose first injury resulted from a fall, 67 (39.0%) fell again. Among persons greater than or equal to 65 years of age with repeat injuries, 61.5% with an initial fall injury suffered a subsequent fall injury. Reported by: JH Holmes, MS, DF Schwarz, MD, JA Grisso, MD, Univ of Pennsylvania; A Wish ner, R Sharrar, MD, RL Sutton, MPH, Philadelphia Dept of Public Health. Epidemiology Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Preliminary results from PIPP surveillance found that in 1 year 12.6% of the study population visited an ER for treatment of injuries caused primarily by falls, interpersonal violence, and motor vehicle incidents. The finding that 9.3% of persons who came to the ER for treatment of an injury returned within 1 year for treatment of another injury has important implications for injury prevention.

Falls and interpersonal violence were the main causes of both initial and repeat injuries. The PIPP data on repeat fall injuries are consistent with other studies that found that once an older person has fallen, the risk of falling again increases substantially (1-3). Accordingly, one aspect of a fall-prevention program for older persons should focus on persons with histories of previous falls.

The occurrence of repeat injuries from interpersonal violence is probably underestimated because such injuries may not have been specifically identified on the ER record as having resulted from interpersonal violence. In particular, many women and children diagnosed as having unintentional cuts, blunt trauma, or falls may have been injured intentionally.

Hospital emergency departments are an important interface between the health-care system and victims of interpersonal violence. One cause of repeat violent injury is interpersonal violence associated with family and intimate relationships (e.g., spouse and child abuse). The introduction of standard protocols in hospital emergency departments for the proper identification, treatment, and referral of victims of family violence has been advocated as a strategy for preventing repeat injury and other consequences associated with family violence (4). This strategy has proven useful in the identification of battered women among trauma patients in emergency departments (5). These strategies can lower mortality and morbidity associated with family violence but require further evaluation.

References

1. Tinetti ME, Williams TR, Mayewski R. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986;80:429-34.

2. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-7.

3. Sattin RW, Nevitt MC, Waller PF, Seiden RH. Injury prevention. In: Abdellah FG, Moore SR, eds. Background papers from the Surgeon General's Workshop on Health Promotion and Aging. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988:D1-20.

4. Klingbeil KS. Interpersonal violence: a comprehensive model in a hospital setting from policy to program (Background paper). In: Report of the Secretary's Task Force on Black and Minority Homicide, and unintentional injuries. Washington, DC: US Department of Health and Human Services, 1986:245-63.

5. McLeer SV, Anwar R. A study of battered women in an emergency department. Am J Public Health 1989;79:65-6.

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