Injury Prevention最新文献

Background: Given that fall injury is a critical public health concern in Australia, understanding the economic implications of falls among older adults is crucial to allocating healthcare resources efficiently to reduce falls and improve quality of life. This study therefore aimed to estimate the cost and identify factors associated with fall-related injuries within residential aged care (RAC).

Methods: A cohort analysis from the healthcare system perspective based on data from a double-blinded randomised controlled trial-the Opti-Med trial. The trial participants were 303 people aged ≥65 years. Identification of in-scope data from the trial dataset was achieved using the falls description note and the National Hospital Cost Data Collection diagnostic related group classification system. Data analyses were performed using STATA V.17. All costs were adjusted to 2022 Australian dollars.

Results: On average, the cost of an injurious fall per incident was $2494 (SD=$6199), while the average cost of falls per resident annum was $1798 (SD=$6002). The potential cost of injurious falls per annum in Australia's RAC system was $325 million. Sex and body mass index (BMI) were identified factors associated with fall injury. There was an inverted U-shaped relationship between BMI and falls risk in RAC.

Conclusions: The healthcare spending on fall injury per resident annum in RAC represents 20% of the 2021-2022 healthcare expenditure per capita. The high cost and inverted U-shaped relationship between BMI and falls risk underscores the need for more effective and RAC-tailored falls prevention strategies in this setting.

Trial registration numbers: Australian New Zealand Clinical Trial Registry (ACTRN12613001204730); WHO Universal Trial (U1111-1148-6094).

Background: The use of electric-powered scooters and bikes (e-scooters/bikes) is rising, but little is known about associated injuries and substance use. This study analysed the trends and factors associated with e-scooter/bike-related injuries and alcohol/substance use emergency department (ED) visits from 2019 to 2022.

Methods: A retrospective analysis of US ED visit data from the 2019-2022 National Electronic Injury Surveillance System (NEISS) identified visits for e-scooter/bike-related injuries. NEISS data were collected using stratified, multistage sampling, and the analysis accounted for this complex sampling design. Outcomes included yearly visits, patient demographics, injury details and alcohol/substance use associations. Multivariable logistic regression analysed factors associated with e-bike/scooter-related injury ED visits and alcohol/substance use.

Results: Of 4020 e-scooter/bike injury ED visits, 3700 (weighted estimate 279 990) were e-scooters and 320 (weighted estimate 16 600) were e-bikes. Visits increased three-fold from 2019 (n=22 835) to 2022 (n=65 892). Most of the injuries involved males, with 79.6% of e-scooter injuries and 79.7% of e-bike injuries), aged 18-39 years (51.5% e-scooter, 48.5% e-bike) and non-Hispanic White (34.9% e-scooter, 38.8% e-bike). Alcohol use was reported in 8.6% of e-scooters and 2.5% of e-bike injury-related ED visits. Males had 2.6 times higher odds of alcohol use (OR: 2.61, 95% CI: 1.84 to 3.69) and 2.2 times higher odds of substance use (OR: 2.23, 95% CI: 1.19 to 4.16) associated ED visits, compared with females. Compared with the 18-39-year age group, those aged 10-17 years had 7.5 and 4.1 times higher odds of alcohol and substance use leading to e-scooter and e-bike injury-related ED visits, respectively.

Conclusions: E-scooter injuries are increasing rapidly, especially among younger males, with a three-fold increase from 2019 to 2022. Alcohol and substance use both contribute significantly to morbidity. Strengthening policy and prevention approaches like the use of helmets are warranted to improve e-scooter/bike safety.

Background: In 2020, Maryland had the fourth-highest opioid overdose mortality rate in the USA. We describe substances identified in postmortem toxicology screening and designated as cause of death (COD) for overdose decedents in Maryland, including specific combinations of substances designated as COD.

Methods: We performed a retrospective analysis of N=5442 adult overdose decedents (ie, manner of death unintentional or undetermined) in Maryland between January 2020 and December 2021. Overdose mortality data from the State Unintentional Drug Overdose Reporting System. Substances were categorised into five major categories: opioids, alcohol, psychostimulants, sedative-hypnotics and psychotropic drugs. Opioids were further divided into prescription opioids (eg, oxycodone, methadone, tramadol) and illicit opioids (eg, illicitly manufactured fentanyl (IMF), heroin).

Results: Opioids were present in 93% of cases and designated as COD for 92%. IMF was the predominant opioid designated as COD (82% of cases), whereas heroin was COD in only 3%. Psychostimulants, predominantly cocaine, were present in 48% of cases and designated as COD in 41%. Opioids alone were COD in 39% of cases, opioids and psychostimulants in combination were COD for 27%, followed by opioids and alcohol (9%), opioids, alcohol and psychostimulants (6%), and opioids and sedative-hypnotics (4%).

Conclusions: IMF is, by far, the leading cause of overdose in Maryland. For more than one-quarter of decedents, opioids and psychostimulants in combination were COD. Specific drug combinations have implications for public health surveillance and harm reduction efforts to keep people who use drugs safer from a volatile drug market and potential fatal overdose.

Background: Since 2014, drowning has received increased political attention. Translating this political commitment to saving lives needs policy-supported evidence-informed interventions. An evidence gap map (EGM) was developed, which aims to facilitate the strategic prioritisation of future research and efficient commissioning of interventions.

Methods: Available evidence was sought by searching four electronic databases using drowning key terms from 2005 to 2023. Peer-reviewed studies, which measured the outcome of a drowning prevention intervention, were included in the EGM. Classification of interventions was guided by the WHO's recommendations for drowning prevention interventions and strategies. Intervention outcomes were classified into health, social, economic, policy and other supporting outcomes.

Results: 49 intervention studies were identified. Of these, 25 studies were conducted in high-income countries (HICs), 19 in low- and middle-income countries (LMICs), 3 in both HICs and LMICs and 2 were not country specific. Interventions, which used community education, were the most common (n=29, 27%), followed by teaching school-age children swimming and water safety skills (n=13, 12%) and others combined (n=66, 61%). Majority of interventions focused on process outcomes such as knowledge acquisition (n=42, 39%) in comparison with objective outcomes such as incidence of drowning mortality (n=21, 19%). No studies reported on interventions that manage flood risks.

Conclusions: Knowledge gaps of effective drowning prevention interventions were identified using an EGM, emphasising the need for methodological advancements reporting on outcomes measures, implementation research and targeted research among high-risk populations in LMICs.

Background: Unintentional falls are the greatest cause of injury-related hospitalisation in adult patients. Frailty is an important contributor to fall risk and poor outcomes in both midlife and older adult trauma patients. Despite this, the incidence of frailty remains understudied among midlife adults, and the CDC fall screening guidelines are limited to older adults. Here, we assessed the incidence of frailty among midlife and older trauma patients in the USA.

Methods: This was a retrospective study using the Trauma Quality Improvement Program database in midlife (aged 50-64 years) and older adult (aged 65 years and older) trauma patients from 2012 to 2021. Frailty was assessed using the five-item Modified Frailty Index. The adjusted change of frailty incidence over the study period was evaluated via Poisson regression.

Results: Frailty incidence in midlife trauma patients rose from 2.4% in 2012 to 5.1% in 2021. The adjusted annual incidence rate ratio (IRR) for midlife frailty was 1.08 (95% CI 1.08, 1.09). Among older adult patients, frailty incidence rose from 6.4% to 14.7%, with an adjusted annual frailty IRR of 1.10 (95% CI 1.10, 1.10).

Conclusion: Frailty is rising in both the midlife and older adult populations, indicating that these groups present increasing risk for unintentional falls and further morbidity and mortality. This underscores the necessity of fall screening in both midlife and older adult patients alongside further explorations into methods to delay the onset of frailty.

Background: Amputations in children represent significant events. Few studies analyse amputations in this specific population, and most of them are old, regionalised and with small sample sizes. Besides, there are no large studies in low-income and middle-income countries. This study aims to analyse a large sample of amputations (19 439 procedures performed in the Brazilian public health system) in children aged 0-14 over 14 years.

Methods: Retrospective cross-sectional population-based analysis of all lower limb amputations performed in the Brazilian public health system between 2008 and 2021 in children up to 14. Using a public database, all types of amputations were selected, defining the number of procedures, their main aetiologies, trends over the years, patient demographics and regional distribution.

Results: 19 439 lower limb amputations were performed in the Brazilian public health system between 2008 and 2021, mainly at the toe level (85%). Amputations occurred predominantly in males (64%) and children aged 0-4 (47%). The global trend is a non-significant decrease in the total number of amputations over the period (p=0.427), but we observe a significant decrease (p<0.001) in amputations in older children (aged 10-14). Amputations are more concentrated in the most populated regions, while the highest mortality is found in the least densely populated areas. Trauma is the main aetiology associated with lower limb amputations in Brazilian children (60%).

Conclusion: The epidemiology of amputations in Brazil differs from the rest of the world. Trauma is the main aetiology.

Background: Suicide rates have increased substantially among Asian American, Native Hawaiian and Pacific Islander (AANHPI) Veterans who are more likely to use suffocation as a suicide method than Veterans overall. This study examined demographic, healthcare and injury characteristics of AANHPI Veterans who died by suicide through suffocation and examined the contexts of these deaths. Analyses further examined if there were differences between AANHPI and non-AANHPI Veterans who died by suffocation suicide.

Methods: This mixed methods analysis used National Violent Death Reporting System (NVDRS) data from AANHPI (n=44) and non-AANHPI (n=3090) Veterans who died by suicide through suffocation (2012-2018).

Results: Hanging comprised nearly all suffocation deaths, although ligature types varied extensively. Residence was the most common location of injury and death, with basements a more common location of death within the home among AANHPI Veterans, relative to a matched, non-AANHPI Veteran sample. There was a significantly higher proportion of females among AANHPI decedents. Additionally, AANHPI decedents were significantly less likely to have emergency medical services present, relative to non-AANHPI decedents. The majority of AANHPI decedents were discovered by family or an intimate partner.

Conclusions: Addressing ligature suicide among AANHPI Veterans is necessary to ensure an equitable suicide prevention approach. Lethal means safety initiatives and postvention strategies that consider salient contextual factors (eg, location of death, discovery by loved ones) are warranted for this population. Considering the ubiquity of ligatures and ligature points, upstream suicide prevention approaches that address drivers of suicide risk are particularly important for preventing suicide among AANHPI Veterans.

Background: Emergency departments are on the front lines of non-fatal self-harm injury (SHI). This study identifies patterns in patients presenting to emergency departments with SHI compared with patients presenting with assault and intimate partner violence.

Methods: Using the National Electronic Injury Surveillance System All Injury Program database, we analyzed SHI cases in the emergency department from 2005 to 2021 and examined demographic characteristics, injury mechanism and anatomic location, emergency department disposition and temporal patterns relative to cases involving assault and intimate partner violence.

Results: Of all injury-related emergency department visits, 1.5% (7 774 900) were due to SHI, 4.8% (24 165 696) due to assault and 0.6% (3 188 790) due to intimate partner violence. SHI peaked in ages 15-19 (18.3%), assault in ages 20-24 (17.3%) and intimate partner violence in ages 25-29 (19.2%). Patients with SHI were 41.0% males, compared with assault (66.3%) and intimate partner violence (19.3%) groups (p<0.0001). Most SHIs involved white patients (75.2%), compared with assaults (46.2%) and intimate partner violence (40.4%) (p<0.0001). Lacerations (20.6%) were the most common injury for SHI, while contusions/abrasions were the most common injuries for both assaults (27.8%) and intimate partner violence (39.1%) (p<0.0001). The upper extremity was the most common injury location in SHI (71.11%), while the head/neck was the most injured area in assaults (58.4%) and intimate partner violence (59.7%). Of adolescents sustaining SHI, 76.7% were women, compared with 59.0% of emerging adults and 53.2% of adults (p<0.0001). Among adolescents, the prevalence of SHI was lowest on weekends and during the summer.

Conclusions: Our findings highlight distinct demographic, injury and temporal patterns observed in patients with SHI.

Objective: The association between alcohol consumption and increased injuries from falls is well established, but there is a lack of data on the prevalence of substance use by fall type. This study aims to describe the distribution of alcohol and drug involvement in injurious falls.

Methods: Using the 2019 National Emergency Medical Services (EMS) Information System data set, we identified 1 854 909 patients injured from falls requiring an EMS response and determined the fall location (eg, indoors or on street/sidewalk). We analysed data on the EMS clinician's notation of alcohol or drug involvement and Glasgow Coma Scale.

Results: Overall, for 7.4% of injurious falls, there was a notation of substance use: 6.5% for alcohol alone, 0.6% for drugs and 0.3% for alcohol and drugs. 21.2% of falls that occurred on a street or sidewalk had a notation of substance use. Substance use prevalence was highest, at 30.3%, in the age group 21-64 years, for falls occurring on streets and sidewalks, without syncope or heat illness as contributing factors. Reported substance use involvement was more frequent for men compared with women for each location type. Glasgow Coma Scale scores indicative of moderate or severe trauma were more prevalent among falls involving alcohol and/or drugs.

Conclusions: Overall, one in five injurious falls on streets and sidewalks and requiring EMS attention involved substance use, and these numbers likely underestimate the true burden. As cities seek to expand nightlife districts, design strategies to protect pedestrians from falls should be enacted.

Introduction: George Floyd's death in 2020 galvanised large protests around the country, including the emergence of the Capitol Hill Autonomous Zone (CHAZ) in Seattle, Washington, a non-policed, organised protest region that may have differing injury risks than other regions. We sought to quantitatively describe characteristics of injuries related to protests documented at visits to two nearby major emergency departments, including the only Level 1 trauma centre in the state.

Methods: Using the International Classification of Diseases, 10th Revision code inclusion criteria, we identified 1938 unique patient visits across the two emergency departments from 29 May 2020 and 1 July 2020. We reviewed provider notes to identify keywords to determine if the visit was related to the CHAZ protest. We quantitatively described demographics and injury characteristics.

Results: We identified 48 injury visits related to the protest, with 25 from assault, 11 from crowd-control weapons and 8 from ground-level falls. Crowd-control weapons consisted of five visits from pepper spray, five from tear gas and a smaller number from flash-bang grenades, rubber bullets or other projectiles or a baton. In terms of body region injuries, 23 involved the head, 13 involved the knee and lower leg and 11 involved the thorax. Five patients required transfer to the operating room for surgery and admission and two died.

Discussion: The demonstrations during the CHAZ in Seattle in 2020 resulted in several violent injuries. Given the high proportion of assault and head injuries, these injury patterns can help prepare healthcare workers and first responders to plan care needs during protests.