The following is a summary of “Impact of a trauma recovery center on emergency department utilization for victims of violence,” published in the March 2023 issue of Endocrinology & Metabolism by Pyles, et al.

Individuals who have experienced violence are at an increased risk for unmet physical and mental health needs, which often lead to more frequent visits to the Emergency Department (ED). Researchers conducted a retrospective cohort study of ED utilization before and after referral to a Trauma Recovery Center (TRC) to explore the effectiveness of a psychosocial, case management-based trauma recovery program on reducing ED visits. 

They reviewed the medical records of TRC participants from June 2017 to May 2019 who had consented to their data being used for research. The primary outcome was the change in ED utilization six months pre- and post-referral to the TRC. The secondary outcomes included factors associated with ED visits after TRC referral, such as victimization and mental health issues.

The study group comprised 143 patients, of whom 82% identified as female and 62% identified as white. A significant portion (39%, n = 56) belonged to one or more vulnerable populations, and the type of victimization varied widely. Intervention uptake was high, with nearly all participants (92%, n = 132) having at least one TRC encounter and 6 encounters (IQR 2-13) per person, with 2.7 services used on average. Most participants (67.1%, n = 96) did not change their ED utilization. Before referral, 40 (28.0%) had at least one ED visit, and after referral, 38 (26.8%) had at least one ED visit, while 81 (56.6%) had no ED visits during either timeframe. There was no significant difference in ED visits per person in the six months before referral compared to the six months after referral (0.52 vs. 0.49, P = 0.76, paired t-test). Negative binomial regression showed that the number of ED visits before referral (IRR 1.5, 95% CI [1.27-1.79]) and pre-existing mental health conditions (IRR 2.2, 95% Cl [0.98-5.02]) were the most strongly associated with an increase in the incidence rate ratio of ED visits in the six months after referral.

In conclusion, the findings suggested that a multidisciplinary TRC did not significantly reduce ED utilization despite high engagement. The most predictive factor of ED utilization after referral to the TRC was the number of ED visits before referral.

Reference: sciencedirect.com/science/article/pii/S0735675722007641