Phenotype-guided selection of venlafaxine and topiramate for vestibular migraine: a narrative review.

Traumatic injury has long been conceptualized as an acute, time-limited event; however, modern trauma epidemiology increasingly supports its characterization as a chronic, relapsing condition marked by recurrent morbidity, repeat injury, and prolonged psychosocial impact [-]. Viewing trauma through this lens shifts the focus of trauma systems from single-episode stabilization toward longitudinal recovery, reinjury prevention, and social reintegration. Long-term studies demonstrate that individuals hospitalized after trauma have up to a 44% likelihood of sustaining another injury within several years, a phenomenon termed “trauma recidivism” []. This pattern is driven by persistent behavioral and social risk factors, such as alcohol use, unstable housing, and limited access to preventive care, which mirror the self-perpetuating mechanisms observed in chronic disease [-]. Readmissions and recurrent emergency department (ED) visits represent measurable manifestations of this chronic course. Smith et al. reported 30-day readmission rates of 11% among trauma inpatients, and ED revisit rates of 13-14%, most often driven by wound complications, musculoskeletal complaints, psychiatric distress, inadequate pain control, or gaps in social support [-]. Unplanned trauma readmissions are costly and frequently preventable. The average per-readmission cost exceeds $10,000, with national expenditures surpassing $313 million annually []. Neiman et al. estimated that roughly one in five trauma readmissions could be avoided, underscoring the need for more deliberate outpatient continuity strategies []. Inpatient data clearly demonstrate the value of trauma-system organization. Staudenmayer et al. found that care in designated trauma centers independently predicted lower unplanned readmission compared with care at non-trauma hospitals, emphasizing that trauma-specific infrastructure improves outcomes even beyond the acute admission []. Whether these benefits extend into the post-discharge phase, however, remains uncertain. Outpatient follow-up has also served as a quality metric, yet emerging evidence suggests that who provides follow-up matters as much as if it occurs. Smith et al. studied 2,266 trauma patients and found no significant reduction in 30-day ED utilization or readmissions among those who obtained generic outpatient follow-up []. The authors suggested that non-trauma providers may be ill-equipped to address the complex clinical and psychosocial needs of trauma survivors. In contrast, structured trauma-directed programs demonstrate tangible benefit. Hall et al. implemented a trauma transitional care program incorporating inpatient identification, early phone outreach, trauma clinic scheduling, and social needs screening, resulting in a significant reduction in 30-day unplanned readmissions []. Among patients with minimal traumatic intracranial hemorrhage, post-discharge healthcare utilization is likely multifactorial. While delayed neurologic complications remain an important consideration, recurrent healthcare encounters may also reflect persistent post-concussive symptoms, medical comorbidities, recurrent falls, functional limitations, or psychosocial vulnerabilities. Distinguishing these contributors is important when evaluating healthcare utilization after telemedicine-guided management.