Recurrent early childhood injuries among disadvantaged children in primary care settings

Objective: To examine differences in social risk factors and health care use between young children with and without recurrent injuries. Design: Retrospective cohort study using administrative claims and medical records. Children with no, one, or more than one injury were compared. Setting: Integrated public healthcare system. Subjects: All children born at Denver Health Medical Center (DHMC) in 1993 who continued care there beyond 15 months of age. Children were followed to 36 months. Outcome measures: Sociodemographic information, service use, injury episodes, cause of injury, and social risk factors. Results: 371 injury episodes occurred among 817 children. In the study cohort, 7% had > 1 injury episode, 26% had one injury, and 67% had none. Among children with > 1 injury episode, 78% had at least one social risk factor compared with 63% of children with one injury and 52% of children with none (p < 0.0001). Risk factors for > 1 injury included maternal substance abuse (p = 0.0003), maternal age under 18 years (p = 0.04), a primary caregiver who was single (p < 0.0001) or mentally ill (p = 0.03), and a history of family violence ( p = 0.01). Multiple injury episodes were associated with increased non-injury service use, including primary care visits (p < 0.0001), emergency department visits (p < 0.0001), and total non-injury encounters (p < 0.0001). Conclusions: Children with recurrent injury were more likely to have social risk factors, and used DHMC more frequently, than children with one or no injuries. Children with risk factors for recurrent injury can be identified and injury prevention counseling can be delivered to their families at their multiple visits to the system.