SUMMARY: A significant minority of trauma sufferers are prone to repeated injury. These trauma recidivists have characteristic behaviours and beliefs. The prognosis for the repeatedly injured is worse than is generally appreciated.
Although Personal Injury claimant counsel characterise their clients as victims of accidental or intentional injury, there is good evidence for many personal factors in what has been called trauma recidivism1 or what is known more popularly as "gladiator syndrome".
Recurrent traumatic brain injury is a special case that is being separately researched, and injury attributed to so-called repetitive stress is also a different issue.
A significant minority of trauma sufferers are prone to repeated injury.
The prevalence of the problem, even in urban studies, varies from 44%2 to one-hundredth of that rate3, depending in part on the geographical location, number of alternative treatment centres monitored and severity of injury.
In one study1, nearly a quarter of trauma sufferers had been hospitalised for previous trauma, and two-thirds of the injuries had occurred during the previous 5 years. In another study4 that compared intentional and unintentional injury patients there was no difference in rates of previous hospitalisation.
It is unknown what proportion of Personal Injury clients suffer repeated injury.
Practice PointPersonal Injury clients who suffer repeated trauma are a distinct group |
These "trauma recidivists" have characteristic behaviours and beliefs.
The term "accident-prone" dates back to 19295. Since then, a large number of studies have provided a composite picture those who suffer repeated injury.
Typically, trauma recidivists experience violence in childhood and adolescent maladjustment6, chronic illness7, pre-existing psychopathology6 (already high in single trauma populations8), social and economical disadvantage9; are male, except for intentional injury6; abuse drugs and alcohol3; and engage in greater amounts of risk-taking behaviour4 - failure to wear seat-belts, excessive drinking, driving after drinking, and in the home keep an unsafe gun and have no smoke-alarm.
After a random search of the driving records of some of the trauma recidivist victims of vehicular accidents, the authors4 were "astonished" at the numbers of prior motor vehicle offences, including non-injury accidents, reckless driving, speeding, drinking-driving, licence suspension and revocation.
In a study10 of the association between smoking and seat-belt nonuse, the risk-takers tended to believe they had a right to put their own health at risk, rather than having an obligation to avoid risks to health. They also underestimated the risk of injury.
The increased amount of risk-taking behaviour by trauma recidivists blurs the traditional distinction between intentional and non-intentional recurrent injury.
Practice PointThe experience, behaviour and beliefs of trauma recidivists constitute a legal "thin skull" for future injury: Experience
Behaviour
Beliefs
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The prognosis for the repeatedly injured is worse than is generally appreciated.
In one series, the five-year mortality rate was 20%2 and one-third of the deaths were caused by repeat trauma.
Practice PointThe injury-prone have a demonstrably reduced life-expectancy |
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