Emergency Department Injury Presentations Research Articles

Injury-Related Emergency Department Presentations Among Residential Aged Care Residents in Victoria, Australia.

This study aimed to quantify and describe the characteristics of emergency department (ED) injury presentations and subsequent hospital admissions among residents of residential aged-care facilities (RACFs) in Victoria, Australia between 2008 and 2018. This study comprised a single jurisdiction population-based study of consecutive injury-related ED presentations of RACFs residents using the Victorian Emergency Minimum Dataset (VEMD). The rate of ED injury presentations per 100,000 population decreased by .8% per year over 10years (P = .03); however, the rate per 100,000 RACF bed days increased by .6% per year (P = .05). The proportion of presentations subsequently admitted to hospital increased 4.0% per year (P<.0001). The majority of presentations were due to falls (82.5%), with fracture(s) being the most common injury type (34.0%). The increased rate of ED visits and hospital admissions in RACFs residents highlights the need to design specialized emergency care services and/or provide better direct access to hospital care for this vulnerable population.

Assessing the impact of Queensland's late-night alcohol restrictions using health system data.

In an attempt to reduce alcohol-related harm in night-time entertainment precincts, the Queensland state government (Australia) introduced the Tackling Alcohol-Fuelled Violence strategy in July 2016, including restrictions on late-night service of alcohol and-later-compulsory ID scanners at venues. In this article, we examined the impact of these changes on emergency department (ED) presentations and hospital admissions for alcohol-related harm. We used data on ED presentations (July 2009-June 2019) and hospital admissions (July 2009-December 2018). Interrupted time series models using seasonal auto-regressive integrated moving average methods were developed to test the impact of the policy change on presentations for alcohol intoxication, any injury or maxillofacial fractures, and admissions for rates of assault-related injuries or maxillofacial fractures. Analyses were conducted using state-wide Queensland data with a sub-analysis focussing on major Brisbane hospitals. The introduction of 3am last drinks and mandatory ID scanners had no significant impact on most outcome measures, either across the state or within Brisbane. State-wide, there was a significant decline in ED injury presentations following the introduction of mandatory ID scanners. The introduction of the Tackling Alcohol-Fuelled Violence strategy in Queensland Safe Night Precincts was potentially associated with a small reduction in injury presentations to EDs. The lack of other impacts may relate to the relative lack of specificity in health system data, which challenges in the implementation of the Tackling Alcohol-Fuelled Violence policies or other local factors.

The impact of street service care on frontline service utilisation during high-alcohol use hours in one night-time entertainment precinct in Australia.

Street service care providers in Queensland, Australia are organisations tasked with assisting vulnerable individuals and aiding intoxicated patrons that are at risk of harm in night-time entertainment precincts (NEP). Members of these organisations patrol NEPs and provide services, such as first aid, to individuals in need. There has been no research conducted on their impact on crime, injuries and on the duties of Australian frontline service resources (e.g. police and ambulance services). This study evaluated the introduction of a single street service care in the Cairns NEP on police-recorded assaults, emergency department injury presentations and ambulance service utilisation during high-alcohol hours. Police-recorded assaults (common and serious), emergency department injury presentations and ambulance attendances for the Cairns suburbs were examined. Autoregressive integrated moving average time series analyses were used to determine the impact of street service care on monthly counts for each dataset. Serious assaults during high-alcohol hours significantly declined after the introduction of the support service in Cairns, with a one-month lagged impact (B = -1.66, 95% confidence interval -3.02, -0.30). No other significant impact on common assaults, emergency department injury presentations or ambulance attendances were found. This study provides preliminary evidence that street service care may help to decrease assaults within a single NEP. However, further research investigating the impact of street services in larger cities, and determining what other roles the service may be able to play in preventing alcohol-related harm, is needed.

Risk-based licensing of alcohol venues and emergency department injury presentations in two Australian states

BackgroundRisk-based licensing (RBL) is among the more recent policy interventions to reduce alcohol-related harm in and around licensed venues. RBL sets licence fees to reflect the venue’s propensity to cause harm as a means of encouraging operators to improve their practices. We assessed whether the introduction of RBL in the Australian states of Queensland and Victoria was associated with a reduction in the incidence of emergency department (ED) injury presentations. MethodsWe employed an interrupted time series design using Prais-Winsten and Cochrane-Orcutt regression modelling to estimate step and slope parameters in injury incidence rates in each state. We defined the population as residents of the state, aged 15–54 years, the age group we considered most likely to be exposed to the night-time economy. To reduce noise, we confined cases to presentations during times previously identified as correlated with a high probability of alcohol involvement, namely ‘high alcohol hours’ (HAH). We adjusted our models for the alcopops tax, implemented shortly before RBL, and for assaults during low alcohol hours (LAH) as a proxy for other risk factors for assault. ResultsRBL was not associated with an overall reduction in the incidence of ED injury presentations during HAH in Queensland (β = 0.003; 95% CI: −0.010, 0.003, p = 0.318) or Victoria (β=−0.010; 95% CI: -0.021, 0.001, p = 0.087). Post-hoc subgroup analyses showed a reduction in ED injury presentations among men aged 20–39 years in Victoria (β=−0.026; 95% CI:-0.012, −0.040, p-0.0003) but this was not replicated in Queensland. ConclusionThere was little evidence that RBL affected the incidence of ED presentations for injury. This may be due to weak financial penalties being applied to venues assessed as high-risk.

Alcohol and injury among attendees at a busy inner city New Zealand emergency department

IntroductionWe present a study that provides a contemporary view of alcohol-related injury prevalence amongst patients presenting to a New Zealand (NZ) emergency department (ED). MethodsAdult injury patients presenting to Auckland City Hospital ED within 6 h of injury were invited to participate during three recruitment periods (2015–2016). An interviewer-administered questionnaire obtained information on demographic, injury, general health, and lifestyle factors. Breath alcohol samples were obtained. Descriptive and logistic regression analyses were conducted. Results501 patients participated (71% response rate), 21% had consumed alcohol within 6 h of their injury. The majority were male, and overall falls were the most common mechanism of injury among all patients. Alcohol-related injuries most commonly occurred at home, and were significantly more likely to occur during the weekend (Friday-Sunday) and night hours (23:00–06:59). After controlling for the effects of confounding; ‘poor’ general health, engaging in leisure activities at the time of injury, and injuries resulting from assaults were associated with increasing the odds of alcohol-related injury. ConclusionsAcute alcohol use continues to play a considerable role in ED injury presentations in NZ. Continued policy, health promotion, and injury prevention efforts are required to reduce the harms associated with alcohol use.

Effectiveness of community-based interventions for reducing alcohol-related harm in two metropolitan and two regional sites in Victoria, Australia.

The relationship between alcohol intoxication and harm is well known, and many community-based interventions have been introduced in an attempt to reduce the rates of alcohol-related harm. The current paper uses two metropolitan and two regional Australian cities as sites to investigate the impact of community-based interventions on the reduction of alcohol-related harms. Data for injury-related emergency department (ED) presentations and police attended assaults during high-alcohol hours (i.e. 20:00-06:00h, Friday and Saturday nights) were obtained for each site from 2000 to 2015 for ED presentations and from 2000 to 2016 for police assaults. Autoregressive integrated moving average time series analyses were conducted to determine the impact of the community-based interventions introduced at each site for reducing these rates of ED injury presentations and police attended assaults. None of the community-level interventions that were introduced across the four sites resulted in a reduction in ED presentation rates or assault rates. The majority of interventions introduced across the four sites were proposed and implemented by local liquor accords. Given none of the interventions demonstrated a reduction in ED injury presentation rates or police attended assault rates, it is argued that local liquor accords may not be best placed to propose alcohol-related harm reduction measures, and instead, there should be a focus on the implementation of evidence-based regulatory strategies, such as restricted trading hours. [Curtis A, Coomber K, Droste N, Hyder S, Palmer D, Miller PG. Effectiveness of community-based interventions for reducing alcohol-related harm in two metropolitan and two regional sites in Victoria, Australia. Drug Alcohol Rev 2017;36:359-368].

Associations between alcohol outlets and emergency department injury presentations: effects of distance from the central business district

ObjectiveTo examine the effects of licensed outlets and sales on levels of alcohol‐related injuries presenting to emergency departments (EDs) in the Inner, Middle and Outer postcode zones of Perth, Australia. MethodsUsing panel data (2002–2010), a surrogate measure (based on day of week and time of day of presentation) was used to identify alcohol‐related injuries presenting at EDs. Postcodes were grouped according to their distance from the central business district (CBD). Numbers of alcohol outlets and their sales were the primary explanatory variables. Data were analysed using negative binomial regression with random effects. ResultsIn the Inner and Outer postcode zones, counts of on‐site outlets were positively associated with alcohol‐related injury (IRR: 1.008; 95%CI 1.003–1.013 and IRR: 1.021; 95%CI 1.013–1.030 respectively). An additional off‐site outlet was associated with 6.8% fewer alcohol‐related injuries (95%CI 0.887–0.980). In the Middle postcode zone, mean off‐site sales were positively associated with injury (IRR: 1.024; 95%CI 1.003–1.044). ConclusionsAssociations between alcohol availability variables and injury differed by outlet type and distance from the CBD. ImplicationsThese findings provide further evidence to support stronger controls on liquor licensing, and indicate the need for different controls according to the location and type of licence.

The effect of alcohol outlets, sales and trading hours on alcohol-related injuries presenting at emergency departments in Perth, Australia, from 2002 to 2010.

Few studies have investigated the combined effects of alcohol sales, outlet numbers and trading hours on alcohol-related harms. This study aimed to test whether associations: (i) exist between alcohol-related emergency department (ED) injuries and alcohol sales and counts of outlets; (ii) vary between on- and off-premises outlets; and (iii) vary by trading hours conditions [extended trading permits (ETP) versus standard hours]. Panel study using 117 postcodes over 8 years (2002-10): 936 data points. Perth, Australia. ED injury presentations, aggregated to postcode-level. Alcohol-related injuries were identified using time-based surrogate measures: night injuries (n=51,241) and weekend night injuries (n=30,682). Measures of alcohol availability included number of outlets with standard and extended trading hours and mean sales per postcode. Negative binomial regression modelling with random effects was used to examine associations between availability and alcohol-related injury, controlling for socio-demographic characteristics. (i) Night injuries were associated significantly with counts of on-premises outlets [incident rate ratio (IRR)=1.046; 95% confidence interval (CI)=1.014-1.078] and sales per off-premises outlet (IRR=1.019; 95% CI=1.004-1.035); (ii) counts of on-premises outlets were positively associated with alcohol-related injury while counts of off-premises outlets indicated a negative association; and (iii) weekend night injuries increased by about 5% per on-premises outlet with an ETP (IRR=1.049; 95% CI=1.015-1.084) and by less than 1% for outlets with standard trading hours (IRR=1.008; 95% CI=1.004-1.013). Regions of Perth, Australia with greater off-premises alcohol sales and counts of on-premises alcohol outlets, particularly those with extended trading hours, appear to have higher levels of alcohol-related injuries.

Alcohol‐related emergency department injury presentations in Queensland adolescents and young adults over a 13‐year period

The rate of alcohol-related emergency department (ED) presentations in young people has increased dramatically in recent decades. Injuries are the most common type of youth alcohol-related ED presentation, yet little is known about these injuries in young people. This paper describes the characteristics of alcohol-related ED injury presentations in young people over a 13-year period and determines if they differ by gender and/or age group (adolescents: 12-17 years; young adults: 18-24 years). The Queensland Injury Surveillance Unit (QISU) database collects injury surveillance data at triage in participating EDs throughout Queensland, Australia. A total of 4667 cases of alcohol-related injuries in young people (aged 12-24 years) were identified in the QISU database between January 1999 and December 2011, using an injury surveillance code and nursing triage text-based search strategy. Overall, young people accounted for 38% of all QISU alcohol-related ED injury presentations in patients aged 12 years or over. The majority of young adults presented with injuries due to violence and falls, whereas adolescents presented due to self-harm or intoxication without other injury. Males presented with injuries due to violence, whereas females presented with alcohol-related self-harm and intoxication. There is a need for more effective ways of identifying the degree of alcohol involvement in injuries among young people presenting to EDs.

Changes in injury‐related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities

Regulatory and collaborative intervention strategies have been developed to reduce the harms associated with alcohol consumption on licensed venues around the world, but there remains little research evidence regarding their comparative effectiveness. This paper describes concurrent changes in the number of night-time injury-related hospital emergency department presentations in two cities that implemented either a collaborative voluntary approach to reducing harms associated with licensed premises (Geelong) or a regulatory approach (Newcastle). This paper reports findings from Dealing with Alcohol-Related problems in the Night-Time Economy project. Data were drawn from injury-specific International Classification of Disease, 10th Revision codes for injuries (S and T codes) presenting during high-alcohol risk times (midnight--5.59 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after the introduction of licensing conditions between the years of 2005 and 2011. Time-series, seasonal autoregressive integrated moving average analyses were conducted on the data obtained from patients' medical records. Significant reductions in injury-related presentations during high-alcohol risk times were found for Newcastle since the imposition of regulatory licensing conditions (344 attendances per year, P < 0.001). None of the interventions deployed in Geelong (e.g. identification scanners, police operations, radio networks or closed-circuit television) were associated with reductions in emergency department presentations. The data suggest that mandatory interventions based on trading hours restrictions were associated with reduced emergency department injury presentations in high-alcohol hours than voluntary interventions.

Trends in paediatric injury rates using emergency department based injury surveillance

The primary aim of this study was to develop a method of calculating paediatric injury rate from Emergency Department injury surveillance data and use this to describe trends in paediatric injury. This study also aimed to establish whether triage category could be used as an indicator of severity. Prospective observational study of paediatric injury in Brisbane, Australia from 1998 to 2005 using Emergency Department injury surveillance data. Injury incidence was calculated using postcode restriction, census data and analysis of injury surveillance data quality and alternative hospital presentations. The incidence of Emergency Department injury presentation increased by 56% between 1998 and 2005. The incidence of injury (adjusted for ascertainment and other hospital presentations) increased from 5,323/100,000/year to 8,316/100,000/year (p<0.01). The overall incidence of admission increased from 1,066/100,000/year to 1,238/100,000/year (p<0.01). The incidence of injury presentations triaged as urgent or above increased by 16% over the study period (2,348/100,000/year to 2,723/100,000/year, p<0.01). Injury incidence can be determined using Emergency Department injury surveillance data and triage category is a useful indicator of injury severity. Paediatric emergency department injury presentations, including serious injury, increased significantly between 1998 and 2005. The methodology used in this study is easily repeatable and could be used to evaluate injury prevention interventions. The prevention and management of injury should be directed by accurate injury incidence data.