Emergency Department Visits For Injuries Research Articles

Emergency Department Usage Patterns Among Pediatric Victims of Gun Violence and Physical Assault.

Violent injuries are a common reason for pediatric emergency department (ED) visits, with gun violence being the leading cause of violent death among children. The objective of this study was to assess for patterns of pediatric ED usage that are associated with future ED visits for violent injuries. This case-control study included youths aged 6 to 19 years who presented to a pediatric ED over a 3-year period due to a physical assault (PA) or their first known gunshot wound (GSW). We compared them with age-, race-, and sex-matched youths presenting for nonviolent medical complaints. All previous ED visits were coded as (1) injuries due to a previous PA, (2) mental/behavioral health visits, (3) sexual/reproductive health visits, (4) sexual assault, or (5) concerns for child abuse. We used multivariate logistic regression to identify patterns of previous ED usage associated with future ED visits for injuries related to PA and/or GSW. The PA and GSW groups used the ED for previous PAs, mental/behavioral health, sexual/reproductive health, sexual assault, and/or child abuse concerns on average 4 to 8 times as often as the control group. Previous ED visits for mental/behavioral health (odds ratio [OR] 5), sexual/reproductive health (OR 3), sexual assault (OR 9), and prior PA (OR 8) were predictive of a future ED visit for PA. Male sex (OR 6) and previous ED visits for PA (OR 5) were predictive of a future ED visit for GSW. Two percent of the PA group and 9% of the GSW group returned to the ED with a subsequent GSW in the following 16 to 40 months. Emergency department visits due to interpersonal violence, mental/behavioral health, sexual/reproductive health, and sexual assault are associated with recurrent ED visits for violent injuries. Awareness of patterns of ED usage may aid in identifying patients at high risk for violence and increase opportunities for preventative interventions.

Urban air pollution and emergency department visits for injury in Edmonton and Toronto, Canada

Air pollution is associated with a broad spectrum of health conditions. Among the reported associations are central nervous system effects, suggesting that air pollution may also affect human behavior and reaction time, which could in turn increase likelihood of injury. Injuries impose a significant public health and economic toll, but to our knowledge the relationship with air pollution has not been examined. This study investigated associations between air pollution and emergency department (ED) visits for injury and poisoning in two Canadian cities (Edmonton, Toronto). Daily concentrations of carbon monoxide, ozone, sulfur dioxide, nitrogen dioxide, and fine particulate matter (PM2.5), and two air quality indexes (AQHI, AQHIX; incorporating O3, NO2, and PM2.5), were considered. A time-stratified case-crossover design and conditional Poisson regression models were used to study short-term exposure effects (0 to 14 day lags). The analysis was done by sex, age group, and season. Significant positive associations were observed in both cities, albeit with some differences in the pattern of effects across strata. Relative risks (RR) and 95% confidence intervals (CI) for an interquartile range (IQR) increase of NO2 (IQR=13.0 ppb, Edmonton) in cold season (October-March) for male were RR=1.012 (95% CI: 1.005, 1.018), 1.025 (1.018, 1.031), 1.026 (1.020, 1.033), and 1.025 (1.019, 1.032), for lags from 0 to 3 days, respectively. The corresponding results in Toronto (IQR=8.8 ppb) were: 1.010 (1.004, 1.017), 1.007 (1.000, 1.013), 1.009 (1.003, 1.016), and 1.007 (1.000, 1.013). The data suggest a potential association between air pollution and increased number of ED visits for injury.

The air quality health index and emergency department visits for injury

Abstract Introduction. The purpose of this study was to investigate the associations of ambient air quality with emergency department (ED) visits for injury. Aim. To explore correlations between ED visits for injury and ambient air pollution. Materials and methods. Considered health outcomes are ED visits for injury (ICD-9 codes: 800-999) in Edmonton, Canada, for the period from April 1998 to March 2002 (1,444 days). Air pollution concentration in the ambient air is represented as a daily maximum of the Air Quality Health Index (AQHI). The AQHI value encapsulates levels of three urban ambient air pollutants (ozone, nitrogen dioxide and fine particulate matter), weighted by constant risk coefficients. A time-stratified casecrossover design, using conditional logistic regression and conditional Poisson regression, was realized to assess the associations. The risk, reported as odds ratio and relative risk, was estimated using log-linear models and parametric non-linear concentrationresponse functions. Results. The strongest effects were observed for young male patients in the cold season (October-March). Lagged exposures were found to have positive statistically significant associations. Discussion. The study results indicate that air quality was associated with increased risk of daily ED visits for injury. This study determined concentration-response functions which allow one to assess the effects for various levels of the AQHI.

Emergency Department Visits for Hand and Finger Injuries Associated with the Use of Log Splitters.

The purpose of this study was to examine patients treated in an emergency department (ED) for injuries related to the use of log splitters. Data were obtained from the National Electronic Injury Surveillance System for the years 2011-2014. National estimates of ED visits for injuries associated with the use of log splitters were obtained, and descriptive epidemiological characteristics are presented. An estimated 37,000 ED visits for injuries related to the use of log splitters occurred during the study period. The majority of injuries occurred to the hand, with lacerations, fractures/avulsions, and amputations being the most common. The findings indicate that injuries from log splitters constitute a serious public health problem. Efforts to reduce injuries are discussed in accordance with the inherent challenges of detailing the circumstances surrounding these injuries.

Epidemiology of Chain Saw Related Injuries, United States: 2009 through 2013

Problem. Chain saws are a commonly used tool with the potential to inflict severe injuries. Methods. Descriptive epidemiological estimates for emergency department (ED) visits for injuries associated with the use of a chain saw were calculated using data from the National Electronic Injury Surveillance System for the years 2009–2013. Results. A total of 115,895 ED visits for injuries related to the use of a chain saw occurred during the study period. Most injury visits occurred among males (95%) and persons aged 30–59 years and during the months of September through November. The main body sites injured were the hand/fingers and knee. The majority of injuries were lacerations (80%). Conclusions. Chain saw injuries present with characteristic patterns which can aid in prevention of injuries related to the use of these tools. Examination of the epidemiology of chain saw injuries will help to ascertain targeted needs for prevention and control efforts.

Identifying Potentially Preventable Emergency Department Visits by Nursing Home Residents in the United States

ObjectivesTo identify and describe potentially preventable emergency department (ED) visits by nursing home (NH) residents in the United States. These visits are important because they are common, frequently lead to hospitalization, and can be associated with significant cost to the patient and the health care system. DesignRetrospective analysis of the 2005–2010 National Hospital Ambulatory Care Survey (NHAMCS), comparing ED visits by nursing home residents that did not lead to hospital admission (potentially preventable) with those that led to admission (less likely preventable). SettingNationally representative sample of US EDs; federal hospitals and hospitals with fewer than 6 beds were excluded. ParticipantsOlder (age ≥65 years) NH residents with an ED visit during this time period. MeasurementsPatient demographics, ED visit information including testing performed, interventions (both procedures and medications) provided, and diagnoses treated. ResultsOlder NH residents accounted for 3857 of 208,956 ED visits during the time period of interest (1.8%). When weighted to be nationally representative, these represent 13.97 million ED visits, equivalent to 1.8 ED visits annually per NH resident in the United States. More than half of visits (53.5%) did not lead to hospital admission; of those discharged from the ED, 62.8% had normal vital signs on presentation and 18.9% did not have any diagnostic testing before ED discharge. Injuries were 1.78 times more likely to be discharged than admitted (44.8% versus 25.3%, respectively, P < .001), whereas infections were 2.06 times as likely to be admitted as discharged (22.9% versus 11.1%, respectively). Computed tomography (CT) scans were performed in 25.4% and 30.1% of older NH residents who were discharged from the ED and admitted to the hospital, respectively, and more than 70% of these were CTs of the head. NH residents received centrally acting, sedating medications before ED discharge in 9.4% of visits. ConclusionThis nationally representative sample of older NH residents suggests ED visits for injury, those that are associated with normal triage vital signs, and those that are not associated with any diagnostic testing are potentially preventable. Those discharged from the ED often undergo important testing and receive medications that may alter their physical examination on return to the nursing facility, highlighting the need for seamless communication of the ED course to NHs.

Screening for violence risk factors identifies young adults at risk for return emergency department visit for injury.

Introduction:Homicide is the second leading cause of death among youth aged 15–24. Prior cross-sectional studies, in non-healthcare settings, have reported exposure to community violence, peer behavior, and delinquency as risk factors for violent injury. However, longitudinal cohort studies have not been performed to evaluate the temporal or predictive relationship between these risk factors and emergency department (ED) visits for injuries among at-risk youth. The objective was to assess whether self-reported exposure to violence risk factors in young adults can be used to predict future ED visits for injuries over a 1-year period.Methods:This prospective cohort study was performed in the ED of a Southeastern US Level I trauma center. Eligible participants were patients aged 18–24, presenting for any chief complaint. We excluded patients if they were critically ill, incarcerated, or could not read English. Initial recruitment occurred over a 6-month period, by a research assistant in the ED for 3–5 days per week, with shifts scheduled such that they included weekends and weekdays, over the hours from 8AM-8PM. At the time of initial contact in the ED, patients were asked to complete a written questionnaire, consisting of previously validated instruments measuring the following risk factors: a) aggression, b) perceived likelihood of violence, c) recent violent behavior, d) peer behavior, e) community exposure to violence, and f) positive future outlook. At 12 months following the initial ED visit, the participants' medical records were reviewed to identify any subsequent ED visits for injury-related complaints. We analyzed data with chi-square and logistic regression analyses.Results:Three hundred thirty-two patients were approached, of whom 300 patients consented. Participants' average age was 21.1 years, with 60.1% female, 86.0% African American. After controlling for participant gender, ethnicity, or injury complaint at time of first visit, return visits for injuries were significantly associated with: hostile/aggressive feelings (Odds ratio (OR) 3.5, 95% Confidence interval (CI): 1.3, 9.8), self-reported perceived likelihood of violence (OR 10.1, 95% CI: 2.5, 40.6), and peer group violence (OR 6.7, 95% CI: 2.0, 22.3).Conclusion:A brief survey of risk factors for violence is predictive of increased probability of a return visit to the ED for injury. These findings identify a potentially important tool for primary prevention of violent injuries among at-risk youth seen in the ED for trauma-related and non-traumatic complaints.

U.S. Emergency Department Visits for Injuries Due to Fireworks, 2006-2010: Have Skyrocketing Sales Led to an Explosion of Injuries?

U.S. Emergency Department Visits for Injuries Due to Fireworks, 2006-2010: Have Skyrocketing Sales Led to an Explosion of Injuries?

Assessment of injury related morbidity, mortality and disability adjusted life years (DALYs) in Cairo, Egypt

BackgroundInjuries cause significant morbidity and mortality globally, particularly in lower and middle income countries such as Egypt. Specific aims: 1-Calculate the frequency of injuries requiring; hospitalisation, emergency department (ED) visits,...

Injuries Related to Snow Blowers in the United States: 2002 Through 2008

The objective was to examine injuries related to the use of a snow blower among patients treated in an emergency department (ED). Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2002-2008. National estimates of ED visits for injuries associated with the use of a snow blower were obtained, and descriptive epidemiologic characteristics assessed. From 2002 through 2008, there were an estimated 32,307 ED visits for injuries related to the use of a snow blower in the United States. Older adults had a higher proportion of ED visits for such injuries than younger age groups. The majority of injuries involved injuries to the hand, with 42% of cases diagnosed with fractures and 20% resulting in amputations. Findings indicate that injuries from snow blowers remain a public health problem. Efforts to reduce injury incidence are discussed in accordance with inherent challenges of prevention of injuries associated with these products.

Injuries associated with the use of riding mowers in the United States, 2002-2007

Context: To examine injuries among patients treated in an emergency department (ED) related to the use of a riding lawn mower. Design and Setting: Data were obtained from the National Electronic Injury Surveillance System for the years 2002-2007. National estimates of ED visits for injuries associated with the use of a riding lawn mower were analyzed. Narrative text entries were categorized to provide a detailed record of the circumstances precipitating the injury. Average annual rates were calculated and logistic regression analyses were employed to determine risk estimates for patient disposition and demographic characteristics related to ED visits for injuries associated with riding mowers. Results: From 2002 through 2007, there were an estimated 66,341 ED visits for injuries related to the use of riding lawnmowers in the U.S., with an average annual rate of 6.0 ED visits per 100,000 males, and 1.6 ED visits per 100,000 females. Older adults had higher rates of ED visits for injuries (7.2/100,000) than younger age groups. The most common injuries involved contusions (24%); sprains/strains (22%) and fractures (17%). The majority of patients (90%) were treated and released the same day. Results of logistic regression analyses revealed that older adults were more likely to be hospitalized when compared to younger age groups; and incidents involving rollovers [OR = 5.45 (95% CI = 3.22-9.23)] and being run over [6.01 (95% CI 3.23-11.17)] were more likely to result in hospitalization when compared to all other circumstances of injury. Conclusions: Riding mowers present injury patterns and circumstances that are different than those reported for push mowers. Circumstances related to injuries and age groups affected were varied, making prevention of riding mower injuries challenging. Application/Impact: Findings support the need to increase awareness and/or change the design of riding mowers with respect to risk of rollover injuries.

Emergency Department Visits for Injury in School‐aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment

To compare the demographic and injury characteristics of children visiting the emergency department (ED) for nonfatal injuries occurring at school with those of same-aged children who were injured outside of school. Data from a stratified probability sample of U.S. hospitals providing emergency services in the National Electronic Injury Surveillance System (NEISS) were analyzed for 2001 and 2002. School and nonschool injury-related ED visits were analyzed for patients who were 5 through 19 years of age. There were an estimated 58,147,518 injury visits in all ages to the ED in 2001 and 2002. Injuries to school-aged children (ages 5-19) accounted for an estimated 15,405,392 (26%) visits overall, of which 1,859,215 occurred at school (16.5% of visits by school-aged children when location of injury was known). Males accounted for 63% of injuries at school; middle-school children (ages 10-14 yr) accounted for a significantly greater proportion of injuries (46%) than did primary- (5-9 yr, 24%) or secondary-school (15-19 yr, 30%) children (p < 0.001). In contrast, for injuries outside of school, secondary-school children were injured most (40%), followed by middle- (32%) and primary-aged children (27%). Nearly 11% of school injuries were classified as violent, whereas only 6.4% of the nonschool injuries in school-aged children were violent (p < 0.001). Similarly, sports injuries were significantly more common at school (53% of injuries) than outside of school (32.9%; p < 0.001). A significant proportion of injuries to school-aged children occur at school. Notable differences exist between the epidemiology of in- and out-of-school injuries. The nature of these injuries differs by age group. Efforts to reduce school injuries will require that these differences be examined further and incorporated into prevention initiatives.

Emergency Department Visits for Injury in School-aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment

Emergency Department Visits for Injury in School-aged Children in the United States: A Comparison of Nonfatal Injuries Occurring Within and outside of the School Environment